Large Bowel Obstruction

Mechanical large bowel obstruction is a surgical emergency because progressive luminal distention can culminate in ischemia and perforation. Delayed diagnosis or treatment is associated with substantial morbidity and mortality; one recent trauma-surgery algorithm cites mortality of 10% to 20%. Wolters Kluwer+1Wolters KluwerAn algorithm of the Journal of Trauma and Acute Care SurgeScienceDirectUnusual causes of large bowel obstruction

Escalate immediately for surgical assessment when examination or systemic findings suggest complicated obstruction. Fever, leukocytosis, tachycardia, and peritonitis are concerning for ischemia or perforation. ScienceDirectScienceDirectBowel Obstruction - an overview Do not defer definitive evaluation because the patient continues to pass liquid stool: diarrhea may be an early manifestation of incomplete intestinal obstruction. dailymed nlm nih+2dailymed nlm nihThese highlights do not include all the information needed to use dicyclomine hydrochloride capsules, USP and dicyclomine hydrochloride tablets, USP safely and effectively. See full prescribing information for dicyclomine hydrochloride capsules, USP and dicyclomine hydrochloride tablets, USP. Dicyclomine hydrochloride capsules USP, for oral use Dicyclomine hydrochloride tablets USP, for oral use Initial U.S. Approval: 1950nctr-crs fdaThese highlights do not include all the information needed to use dicyclomine hydrochloride safely and effectively. See full prescribing information for dicyclomine hydrochloride. <br/> <br/> <br/> <br/> <content styleCode="bold"> <content styleCode="bold">DICYCLOMINE</content> hydrochloride capsules, for oral use </content> <br/> <br/> <content styleCode="bold"> <content styleCode="bold">DICYCLOMINE</content> hydrochloride tablets, for oral use </content> <br/> <br/> <content styleCode="bold">Initial U.S. Approval: 1950</content>dailymed nlm nihDICYCLOMINE HYDROCHLORIDE

CT has become the standard imaging approach for identifying the site, severity, and etiology of large bowel obstruction. ScienceDirectScienceDirectUnusual causes of large bowel obstruction It provides more actionable information than plain radiography because it can define the transition point, identify a mass, volvulus, stricture, or extrinsic disease, and evaluate for complications. ScienceDirect+1ScienceDirectBowel Obstruction - an overviewScienceDirectUnusual causes of large bowel obstruction

Plain abdominal radiography can support the initial assessment but is insufficient as the sole definitive study when the cause and anatomic level remain uncertain. A cited review reports sensitivity of 84% and specificity of 72% for plain radiographs, whereas CT adds diagnostic information regarding cause and location. ScienceDirectScienceDirectBowel Obstruction - an overview

For patients in whom diverticulitis is a potential cause, IDSA suggests CT as the initial imaging modality in nonpregnant adults; CT can identify complications including perforation, abscess, bowel obstruction, bleeding, and fistula while also evaluating alternative causes of abdominal pain. IDSAIDSAIDSA 2024 Guideline Update on the Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation of Complicated Intra-abdominal Infections in Adults, Children, and Pregnant People

Initial management centers on prompt fluid resuscitation and correction of electrolyte abnormalities. Nature+1NatureManagement and Imaging of Large Bowel ObstructionScienceDirectBowel Obstruction - an overview Decompression may be necessary according to symptom burden and obstruction level; however, one review notes that vomiting is less common in large bowel than small bowel obstruction, so nasogastric decompression is not uniformly required. ScienceDirectScienceDirectBowel Obstruction - an overview

The definitive plan depends on whether the obstruction is malignant, benign structural, volvulus-related, or pseudo-obstruction and on whether ischemia, perforation, or peritonitis is present. Wolters Kluwer+2Wolters KluwerEvidence-based, cost-effective management of... : Journal of Trauma and Acute Care SurgeryScienceDirectBowel Obstruction - an overviewScienceDirectUnusual causes of large bowel obstruction Large bowel obstruction may require urgent or emergent surgery. Wolters KluwerWolters KluwerAn algorithm of the Journal of Trauma and Acute Care Surge

Acute colonic pseudo-obstruction can mimic mechanical obstruction clinically and radiographically but lacks distal mechanical occlusion. dailymed nlm nih+2dailymed nlm nihThese highlights do not include all the information needed to use dicyclomine hydrochloride capsules, USP and dicyclomine hydrochloride tablets, USP safely and effectively. See full prescribing information for dicyclomine hydrochloride capsules, USP and dicyclomine hydrochloride tablets, USP. Dicyclomine hydrochloride capsules USP, for oral use Dicyclomine hydrochloride tablets USP, for oral use Initial U.S. Approval: 1950nctr-crs fdaThese highlights do not include all the information needed to use dicyclomine hydrochloride safely and effectively. See full prescribing information for dicyclomine hydrochloride. <br/> <br/> <br/> <br/> <content styleCode="bold"> <content styleCode="bold">DICYCLOMINE</content> hydrochloride capsules, for oral use </content> <br/> <br/> <content styleCode="bold"> <content styleCode="bold">DICYCLOMINE</content> hydrochloride tablets, for oral use </content> <br/> <br/> <content styleCode="bold">Initial U.S. Approval: 1950</content>dailymed nlm nihDailyMed - DICYCLOMINE HYDROCHLORIDE- dicyclomine hydrochloride tablet CT is therefore important before assigning the syndrome or pursuing a pseudo-obstruction-specific treatment strategy. The supplied results identify contemporary ASCRS guidance addressing both colonic volvulus and acute colonic pseudo-obstruction but do not provide sufficient full-text recommendations to specify pharmacologic or endoscopic treatment thresholds. Wolters KluwerWolters KluwerEvidence-based, cost-effective management of... : Journal of Trauma and Acute Care Surgery

Diverticulitis can cause large bowel obstruction as a complication. IDSA recommends CT as initial imaging for suspected diverticulitis in nonpregnant adults because it identifies complications including obstruction and perforation. IDSAIDSAIDSA 2024 Guideline Update on the Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation of Complicated Intra-abdominal Infections in Adults, Children, and Pregnant People A surgical review notes that complicated diverticulitis with perforation, obstruction, abscess, or fistula is generally managed surgically or by interventional radiology rather than by outpatient uncomplicated-diverticulitis pathways. ccjmccjmAcute left-sided colonic diverticulitis: A surgeon's ...