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From the Department of Large bowel obstruction (LBO) is a serious and costly medical condition, indicating often
Surgery, University of Buea,
Abstract
emergency surgery. The main clinical issue is to determine whether the obstruction affects the
Buea, Cameroon small bowel or the colon since the causes and treatments are different. Delay in operative
intervention may lead to an unnecessary bowel resection, increased risk of perforation, and
overall worsening of patient morbidity and mortality. With the advent of colonic endoluminal
stent, the treatment of distal colonic obstruction should be individually tailored to each patient.
This article discussed LBO and emphasized the importance of history taking, examination, and
basic imaging in the early diagnosis of its cause, thus facilitating appropriate management.
Received: January, 2017.
Accepted: January, 2017. Key Words: Examination, history, large bowel, obstruction, resuscitation, treatment
Discussion
LBO may be mechanical (lumen partly or
completely blocked) or paralytic (no peristalsis).
It may be chronic, acute‑on‑chronic, acute, or
pseudo obstruction (nonmechanical). In fact, there
is a complete spectrum of clinical presentation
and patients may present with acute LBO without
a preexisting history of obstructive
symptoms.[5,6] The visceral pain of intestinal
obstruction is due to increased gut peristalsis
against the obstruction and is usually referred
features of a right‑sided LBO may be less obvious
of transverse colon) colicky pain is carried by the
than those of left‑sided colonic lesions because
lesser splanchnic nerve (T10–T11) and referred to the
only a small proportion of the colon is distended.
umbilicus while hindgut (beyond the distal third of
However, an obstruction at the ileocecal valve
transverse colon) colicky abdominal pain being carried
will produce features of a low small bowel
by the least splanchnic nerve (T12) is referred to the
suprapubic area. The other sources of pain are somatic obstruction.[5,11] A closed loop obstruction may
(localized) from abdominal distension and peritoneal follow an acute‑on‑chronic LBO from a distally
irritation when ischemia or perforation obstructing colonic
supervenes.[7,8]
The main causes of LBO are malignancy and volvulus Address for
of the sigmoid colon [Table 1]. The prevalence of both correspondence:
Dr. Elroy Patrick Weledji, E‑mail:
is subject to a wide geographical variability.[5,6] elroypat@yahoo.co.uk
Colorectal cancer is particularly prevalent in the west,
accounting for at least 50% of LBO. This proportion This is an open access article distributed under the
terms of the Creative Commons Attribution-
alters in Africa and Eastern Europe where sigmoid
NonCommercial-ShareAlike 3.0 License, which
volvulus is the cause of obstruction in up to 40% of allows others to remix, tweak, and build upon the
cases.[9,10] The most common site of LBO is the work non-commercially, as long as the author is
sigmoid colon, accounting for 50% of all cases. This is credited and the new creations are licensed under
the identical terms.
not only because the sigmoid colon is a common site
For reprints contact: reprints@medknow.com
for colonic carcinoma but also because the lumen is
relatively narrow and the feces are firm rather than
How to cite this article: Weledji EP.
liquid. The second most common site is the splenic
Perspectives on large bowel obstruction. IJS
flexure (10%), where the combination of a sharp kink Short Rep 2017;2:1-4.
in the colon together with luminal narrowing by the
tumor and relatively firm stools leads to blockage. The