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Overview of mechanical colorectal obstruction

Authors
Daniel Dante Yeh, MD
Liliana Bordeianou, MD, MPH
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. Although small bowel obstruction is more common, large bowel obstruction occurs in approximately 25 percent of all intestinal obstructions [1]. Obstruction can be functional (due to abnormal intestinal physiology) or due to a mechanical obstruction, which can be partial or complete. Depending upon the time course of development of the obstruction, symptoms related to colorectal (large bowel or rectum) obstruction can present acutely with abdominal pain and obstipation, or more chronically as a progressive change in bowel habits.

The clinical features, diagnosis, and management of mechanical colorectal obstruction are reviewed here. Fecal impaction is considered a form of functional obstruction, and is reviewed separately. (See "Constipation in the older adult", section on 'Fecal impaction'.)

PATHOPHYSIOLOGY

Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted. Obstruction can be functional (due to abnormal intestinal physiology) or due to a mechanical obstruction (extrinsic or intrinsic [mural or intraluminal]), and can be partial or complete.

On average, patients with acute symptoms present after an average of five days of symptoms [2]. This delay may be related to the nature of the symptoms with abdominal distention and discomfort from progressive colonic distention possibly better tolerated compared with abdominal pain and vomiting associated with small bowel obstruction.

About 70 percent of large bowel obstructions occur at or distal to the transverse colon (figure 1) [2,3]. Tumors at the hepatic flexure are the least common. Tumors of the splenic flexure are more likely to result in obstructive symptoms. Perforation may also be present and occurs more commonly at the point of obstruction, most likely due to local tumor invasion or inflammatory reaction, rather than in the proximal, dilated colon.  

                       

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 31 00:00:00 GMT 2015.
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