Large bowel obstruction in adults is not as acute as that of the small bowel. One of the common causes of colonic obstruction is diverticulitis with a pericolic abscess formation, which can lead to obstruction. Another cause is a circumferential cancerous growth inside the colon, which eloped detection until it came to the point where obstruction occurred. Less common causes are colonic Crohn’s disease and volvulus of the cecum or of the sigmoid colon.
There is usually an increasing constipation problem, which is associated more and more with abdominal distension and less frequent bowel movements. There might be blood in the stool in the cases of a bleeding cancer, but this is a late sign. A volvulus has a different , more acute presentation as the strangulation leads to excruciating abdominal pain (see above under “volvulus”). Depending on the underlying pathology as mentioned above, the symptoms are slightly modified. For instance, with a volvulus in the cecum the pain is localized in the right lower abdomen. However, with diverticulitis the abdominal pain is located either in the mid abdomen (if the transverse colon has been affected) or in the left mid or lower abdomen (with involvement of the descending or sigmoid colon). The same is true for cancer of the colon, which mostly is located in the rectum, the sigmoid colon or descending colon, all of which would give obstructive symptoms with pain in the left mid and left lower abdomen and possibly with a rectal fullness (in rectal cancer).
Treatment is similar to small bowel obstruction in that the patient has to be stabilized first and then a laparotomy is performed, which usually tells the surgeon exactly what is going on and the appropriate procedure can be done to correct it. A cancer would be removed in the healthy adjacent colon and the the two ends be reconnected. Similiarly, with diverticulitis the affected colon segment has to be removed and the healthy colon ends are then anastomosed as mentioned before. Often with diverticulitis the tissue is very brittle or one of the diverticles has perforated and caused a localized peritonitis, which was walled off by the fat apron (called “omentum”). In this case the surgeon may be forced to only do a colostomy (=opening from the colon to the skin) and resection of the diseased bowel. The reconnection surgery would have to wait 2 or 3 months until the infection has completely healed and it is considered safe for the patient to undergo the surgery.
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