Large Bowel Obstruction

A carcinoma is the leading cause of large bowel obstruction, while volvulus and diverticulitis account for most of the remaining cases. All of these precipitating conditions are more common in the elderly. The overall mortality rate approximates 40 percent. Distention is common, vomiting and constipation are reported in about half the patients. Importantly, a significant percentage (up to 20 percent) will report diarrhea. A history of rectal bleeding, altered bowel habits, or weight loss may be present with underlying carcinoma.12 The pain is usually gradual in onset; however, cecal volvulus can present with the acute onset of severe, colicky pain. 17 Sigmoid volvulus is two to three times more frequent than cecal volvulus and more commonly presents with a gradual onset of pain.18 Fever or the presence of peritoneal irritation suggests a perforation or gangrenous bowel.

The principal diagnostic study is plain abdominal radiography; however, cecal volvulus may appear as small bowel obstruction and require a barium enema to make the diagnosis.17 In one large series, a cecal diameter of 10 cm was not useful in predicting perforation. In fact, cecal diameters of up to 20 cm responded to routine decompression methods.12 Colonic pseudoobstruction, also known as Ogilvie's syndrome, can present in a manner similar to that of large bowel obstruction. This is massive gaseous distention of the colon, generally occurring in chronically ill, immobilized older patients. The abdomen is distended and tympanitic but usually nontender. A cavernous rectal vault is an important clue on physical examination. Old medical records frequently reveal several such presentations. It is important to avoid surgery in these patients as there is no underlying mechanical blockage. 19

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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