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Large Bowel (Intestinal) Obstruction

The large bowel, also called the large intestine, is a part of your body that helps you remove waste. The leftover waste from the digested food enters your large bowel as liquid. Your large bowel absorbs water and changes the liquid to stool.

What is large bowel obstruction?

Large bowel (intestinal) obstruction occurs when there is a blockage in the large bowel that prevents food from passing through. The blockage cuts off blood supply to the bowel and a part of it dies. When this happens, the pressure causes a leak that spreads bacteria into the body or blood.

What are the causes/risk factors of large bowel obstruction?

  • Cancers of the:
    • Colon (primary cause)
    • Stomach
    • Ovary
    • Lung
    • Breast
  • Abdominal surgery
  • Abdominal radiation

What are the symptoms of large bowel obstruction?

The most common symptoms are:

  • Not being able to pass gas
  • Not being able to have a bowel movement
  • Nausea
  • Vomiting
  • Bloating
  • Abdominal swelling
  • Abdominal pain

The pain usually comes in sharp waves and then gets better for awhile.

Who is at risk of a large bowel obstruction?

People who:

  • Are any age, but more often those over 70
  • Have had surgery on abdomen
  • Have had radiation therapy on abdomen
  • Have/have had a form of cancer

Note: Fewer than one in three colorectal cancer patients actually develop large bowel obstruction.

What is the risk of developing large bowel obstruction?

The risk that you will develop the disease is 1.47 per 100,000 persons per year.

How is large bowel obstruction diagnosed?

  • Physical exam: The doctor will check to see if you have abdominal pain, vomiting, or any movement of gas or stool in the bowel.
  • Complete Blood Count (CBC): Your blood will be checked for:
    • The number of red blood cells, white blood cells, and platelets
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
    • The portion of the blood sample made up of red blood cells
  • Electrolyte panel: A blood test that measures the levels of electrolytes, such as sodium, potassium, and chloride.
  • Urinalysis: A test to check the color of urine and its contents--such as sugar, protein, red blood cells, and white blood cells--is performed.
  • Abdominal x-ray: An x-ray of the organs inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Barium enema: A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the large bowel and x-rays are taken. This test may show what part of the bowel is blocked.
  • CT (computed tomography--also called CAT) scan: This scan makes detailed pictures of areas inside of the body.
  • Colonoscopy: A doctor inserts a colonoscope into the rectum. This scope is a long, flexible tube-like instrument. It allows the transmission of an image of the colon lining onto a screen for the doctor to view.

How is large bowel obstruction treated?

There are different treatments depending on the type of bowel obstruction you have. If you have a sudden and short-term bowel obstruction, it will be treated by:

  • Fluid replacement therapy: A treatment to get the fluids in the body back to normal amounts. Intravenous (IV) fluids may be given and medicines may be prescribed.
  • Electrolyte correction: A treatment to get the right amounts of chemicals in the blood, such as sodium, potassium, and chloride. Fluids with electrolytes may be given by infusion.
  • Surgery: Surgery may be done if serious symptoms are not relieved by other treatments.

If you have a long-term bowel obstruction, it will be treated by:

  • Surgery: The obstruction is removed to relieve pain and improve quality of life.
  • Stent: A metal tube inserted into the bowel to open the area that is blocked.
  • Medicines: Injections of medicines may be given to you to relieve symptoms. These medications can be used to treat pain, nausea, fullness of bowel, or more than one symptom.

What are the side-effects associated with treatment?

  • Stent treatment:
    • If you have a rectal tumor within 2 cm. of the anus, inserting a stent can lead to tenesmus. With tenesmus, you feel like you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping. Inserting a stent may also lead to incontinence (uncontrollable urination).
    • Perforation (tearing)
    • Bleeding
    • The stent can travel inside the body
  • The obstruction can occur again
  • Opioids can aggravate the gastrointestinal system
  • After gastrostomy tube is inserted:
    • Abdominal wall pain may occur.
    • The tube can fall out of place and travel around in the body.
    • Bleeding may occur.
    • Catheter (flexible plastic tube that is placed into your bladder to drain urine) can travel around in the body.

What are the outcomes and what should be expected after treatment?

Emergency surgery has a high risk of death, especially for the elderly with other health problems. A better option is the stent treatment. Stent treatment is safer and more successful than surgery.

What is the outlook of large bowel obstruction (prognosis)?

The outlook is good if the blockage is removed early. This is not true for people in the advanced stages of cancer and the elderly with other health problems because they cannot withstand surgery.

How can you prevent large bowel obstruction?

  • Get any unusual colon or rectal symptoms checked out (for example, constipation and abdominal pain)
  • Get screened for colon or rectal cancer regularly

Research and clinical trials

There are a lot of different clinical trials comparing the different treatment options. These trials find out which treatment is the safest and has the best results. Also, some new drugs are being tested for their effectiveness.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/20/2013…#15287

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