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Imaging of Uncommon Causes of Large-Bowel Obstruction

Large-bowel obstruction (LBO) is approximately five to six times less common than small-bowel obstruction (SBO) and is more common in elderly patients. The causes of LBO and SBO differ substantially. Patients with LBO typically present with abdominal pain, distention, and constipation. LBO uncommonly may also present acutely, such as in cases of volvulus...

The left colon is the most common site for LBO. Primary colon carcinoma (60–80%) and volvulus (10–15%) are the most frequent causes of LBO. Less common causes of LBO include diverticulitis (5–10%), inflammatory bowel disease (IBD), bowel ischemia (4–8%), fecal impaction, and other uncommon and unusual diagnoses (fewer than 5%).

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Articles of Interest

Current management of large bowel obstruction: a narrative review

Large bowel obstruction (LBO) is a common colorectal surgical emergency. Symptoms and presentation may be subtle or profound. Causes can range from inflammatory to malignant. Historical approaches have been limited to surgery with stoma formation. With advances in procedural techniques, management has evolved and is tailored to disease specific strategies. The use of endoscopic stents and the highly selective use of stomas have greatly improved outcomes. The objective of this article is to provide a contemporaneous narrative review of the management of LBO.

Endometriosis: A Rare Cause of Large Bowel Obstruction

Large bowel obstruction can result in significant morbidity and mortality, especially in cases of acute complete obstruction. There are many possible causes, the most common in adults being colorectal cancer. Endometriosis is a benign disease, and the most affected extragenital location is the bowel, especially the rectosigmoid junction. However, transmural involvement and acute occlusion are very rare events.

Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes

Although large bowel obstruction (LBO) is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients. However, further evaluation with multidetector computed tomography (MDCT) has become the standard of care to identify the site, severity, and etiology of obstruction.

Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes

Although large bowel obstruction (LBO) is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients.

Large Bowel Obstruction With Cecal Perforation: What’s the Cause?

Bowel obstruction is they key finding in a significant number of surgical abdomens, accounting for one-fifth of all cases. Of these cases, large bowel obstructions account for 20% to 25%. Among the several possible causes of large bowel obstruction, the most prevalent in the United States is neoplasm (60% of cases); other causes include diverticulitis (20%), volvulus (5%), intussusception, inflammatory bowel disease, congenital megacolon, and fecal impaction/obstipation.

The Sick Bowel Obstruction Patient

For LBOs, most common cause is by far malignancy (~60%). Sigmoid volvulus shows up as the “coffee-bean” sign, more common in elderly and nursing home patients. Cecal volvulus points to the left upper quadrant and is typically seen in a younger patient (20-60 years old).

Resources

Applied Radiology

Large-bowel obstruction (LBO) is much less common than small bowel obstruction but is considered an abdominal emergency. The etiology of bowel obstruction varies by age. In neonates, the most common causes include intestinal atresia, meconium ileus, Hirschsprung disease, and malrotation. In older children, adhesions can often cause obstruction, with approximately 5% of children having had abdominal surgery develop adhesions resulting in bowel obstruction. Other causes include intussusception and inflammatory bowel disease. In the adult population, malignancy remains the most common cause. Presenting symptoms include abdominal pain, distension, obstipation, and peritonitis if perforation occurs.

StatPearls

Large bowel obstruction usually presents as an emergency with sepsis, dehydration, and hemodynamically compromised state. The most common cause of large bowel obstruction is colorectal cancer.

WikEM

Obstruction originating from the left colon is likely to manifest with symptoms earlier than obstruction originating from the right colon, because the lumen from the descending colon and the sigmoid is smaller.