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Large Bowel Obstruction (Clinical Presentation (Palpable mass e.g. hernia,…
Large Bowel Obstruction
Epidemiology
Less common, accounting for only 25% of all intestinal obstruction
Acute presentation
Large bowel has a larger lumen as well as circular and longitudinal muscles thus the ability of the large bowel to distend is much greater thus symptoms present slower and later than in SBO
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Pathophysiology
There is increased colonic pressure and decreased mesenteric blood flow resulting in mucosal oedema - transudation of fluid and electrolytes from the lumen
This can compromise the arterial blood supply and also cause mucosal ulceration resulting in full thickness necrosis as well as perforation
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In colonic volvulus:
There is axis rotate based off mesentery and a 360 degree twists results in a closed loop obstruction
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Ischaemia, necrosis and perforation of the loop of the bowel soon follows if untreated
Clinical Presentation
Palpable mass e.g. hernia, distended bowel loop or caecum
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Diagnosis
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Abdominal X-ray
Peripheral gas shadows proximal to the blockage e.g. in caecum but NOT in rectum, unless PR examination done (this is always essential)
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