Tuesday, April 14, 2009
Large Bowel Obstruction
I've had a run of large bowel obstructions (LBO) lately. The images above are illustrative. When we talk about "bowel obstruction", usually we're referring to small bowel obstruction (SBO), generally caused by adhesions and scar tissue from previous surgery. SBO's can be managed non-operatively about 75% of the time.
LBO is a different animal. Adhesions don't (in general) cause an obstruction of your colon. Cancer, volvulus, and hernias are the usual culprits and an operation is often mandated. A colonic obstruction is technically a surgical emergency. The cecum is very thin walled and, with the ileocecal valve, can form a closed loop situation with a distal obstruction. Ischemia and frank perforation are eventual consequences. The resultant poopy belly is not in anyone's best interest.
The first picture shows a dilated cecum secondary to a hepatic flexure tumor. Pictures 2 and 3 demonstrate a LBO caused by a splenic flexure cancer. Both patients had formal resections with primary anastomoses.