Diagnosis Of Large Bowel Obstruction Research Articles

AN UNUSUAL PRESENTATION OF OGILVIE'S SYNDROME

Introduction: Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, refers to pathologic dilation of the colon without underlying mechanical obstruction, occurring primarily in patients with severe comorbidities. Acute colonic pseudo-obstruction appears to be more common in men and patients over the age of 60 years. The incidence is approximately 100 cases per 100,000 hospital admissions per year. Aims And Objectives The study aims to discuss an unusual presentation of Ogilvie's syndrome Objectives: Ÿ Discuss the aetiologies and management of Ogilvie's syndrome Methods: Results: Conclusion: We will be discussing a case of Ogilvie's syndrome. The differential diagnosis of large bowel obstruction. A large bowel obstruction warrants immediate surgical management whereas Ogilvie's syndrome is one of the rare cases of large bowel obstruction which is to be managed conservatively.

Radiological diagnosis of large-bowel obstruction: nonneoplastic etiology

Large-bowel obstruction (LBO) is a relatively common abdominal emergency. Computed tomography (CT) diagnosis of LBO is often easy, but it is essential to clarify LBO etiology and to decide how to treat it. Therefore, it is important for the radiologist to become familiar with the imaging findings of LBO, including plain radiography and CT, to determine its various causes, as well as the many diseases mimicking LBO. In this article, we show the characteristics of radiological findings of plain radiograph, barium study, and CT and their correlations with pathologic findings. LBO etiology comprises two main categories: neoplastic and nonneoplastic disease. However, the primary causes of LBO are neoplastic etiologies, and nonneoplastic causes are relatively uncommon and unfamiliar to many radiologists in clinical practice. Therefore, in this review, we present nonneoplastic etiology of LBO and diseases simulating LBO and provide critical information concerning the causes of LBO and viability of the involved bowel loops.

The demise of the instant/unprepared contrast enema in large bowel obstruction

Imaging the colon in suspected acute large bowel obstruction (LBO) is traditionally carried out with a supine abdominal X-ray (AXR) and erect chest X-ray. If there is no clinical or radiological evidence to suggest a perforation, then an unprepared barium or water-soluble contrast enema (CE) can be performed to confirm the presence of and demonstrate the site of obstruction. The advent of modern, fast multidetector CT (MDCT) scanners has changed management strategies for acute abdominal conditions including suspected LBO in all groups of patients especially the elderly, infirm and those on ITU/HDU. A retrospective case note analysis was carried over a 7-year period in a single centre. The study criteria involved investigation of suspected LBO with CE, CT and MDCT. It showed a reduction in the number of contrast enemas performed. MDCT was shown to be more accurate in the diagnosis of LBO, is usually available on a 24-h basis, and in many institutions has replaced the urgent CE in this group of patients. This also has the advantage of excluding incidental findings and in staging malignant disease.

Large bowel obstruction in pregnancy: a rare entity, an unusual cause

Large bowel obstruction is a rare and difficult diagnosis in pregnancy. Common causes are caecal and sigmoid volvulus and less common pseudo-obstruction. An infrequent cause of large bowel obstruction from an adhesive band in pregnancy causing diagnostic difficulty is reported. Report of an unusual cause of large bowel obstruction in pregnancy. Diagnostic colonoscopy confirmed large bowel obstruction at the level of sigmoid. Laparotomy revealed this to be from a single band adhesion originating from the site of previous appendicectomy. Division of the band resolved the obstruction. A high index of suspicion is necessary for the diagnosis of large bowel obstruction in pregnancy especially in women with previous history of abdominal or pelvic surgery. Colonoscopy is helpful avoiding radiation to foetus and mother. Prompt surgical intervention reduces risks and maximises chances for a favourable outcome for both mother and child.

Cholecystocolonic fistula: an unusual cause of large bowel obstruction

A 70-year-old woman was admitted to the emergency department with a 2-week history of pain in the upper abdomen, vomiting, fever and jaundice. She was also complaining of pale stool and dark urine. Subsequently she developed abdominal distension with colicky pain and absolute constipation. There was no history of previous biliary symptoms. On examination she was pale and tachycardic with a fever of 37.9°C. Abdominal examination revealed generalized abdominal distension with a tender mass at right upper quadrant and hyperactive bowel sounds on auscultation. Laboratory examination showed a white blood cell count of 15 600/mm3 (neutrophil 85%), bilirubin of 47mmol/litre, alkaline phosphatase of 220 U/litre with normal liver enzymes and amylase. Plain abdominal X-ray demonstrated pneumobilia and dilated small and large bowel loops suggestive of intestinal obstruction (Figure 1). An unprepared barium enema showed a large smooth filling defect in sigmoid colon with large bowel obstruction (Figure 2). A diagnosis of large bowel obstruction presumably caused by a gall-stone was made. Surgical treatment followed a period of physiological optimization. At laparotomy the abnormalities were large bowel obstruction caused by an impacted gall-stone in a section of sigmoid diverticular disease plus right upper quadrant mass. A sigmoid colectomy with removal of diverticular disease and the stone, then a primary anastomosis was performed. Exploration of right upper quadrant mass revealed an inflamed friable gall bladder with a fistula between its fundus and the transverse colon. A partial cholecystectomy was performed, the cystic duct closed in-situ and the defect in transverse colon was brought out as a loop colostomy. Her postoperative course was uneventful. Closure of colostomy was performed 3 months later and she made a full recovery.

Cherry pit ingestion leading to diagnosis of colon carcinoma

A 80-year-old man was admitted to the hospital with ahistory of recurrent attacks of crampy abdominal pain, nau-sea, and vomiting, and without passage of flatus and feces.On physical examination, the patient’s abdomen was dis-tended and remarkably tender to palpation. Bowel soundswere increased. Laboratory findings were unremarkable ex-cept for an elevated hemoglobin level of 18 g/dL. Abdom-inal radiographs revealed a dilated large bowel with multi-ple air fluid levels. The patient was admitted with thepresumptive diagnosis of large bowel obstruction. He un-derwent an abdominal computed tomography scan (Fig. 1),which demonstrated a ring-like foreign body with surround-ing mucosal thickening in the descending colon (arrow).Exploratory laparotomy revealed a large bowel obstructionwith a carcinoma of the descending colon. A left-sided colec-tomy and a transverse colostomy were performed. Examina-tion of the resected specimen showed an annular ulcerativecarcinoma of the descending colon and two cherry pits lodgedin the encircling tumor (Fig. 2). The patient had an unevent-ful postoperative course and was discharged in stable condi-tion.Swallowed fruit pits are no doubt much more commonthan realized. Rarely, they cause symptoms [1], and morerarely, intestinal obstruction [2]. Patient education mightreduce the instances of ingested pits, but on the other hand,ingestion may lead to an earlier diagnosis of a carcinoma.References

Complete large bowel duplication with paraduodenal cyst: prenatal sonographic features

To illustrate diagnostic dilemmas while considering a diagnosis of complete large bowel duplication and duodenal duplication cysts. A case of large bowel dilatation with a peripancreatic cyst was identified sonographically in a 27-year-old gravida 3 at 35 weeks of gestation, suffering from gestational diabetes and pregnancy-induced hypertension. On the basis of sonographic findings of dilated, hyperperistaltic large bowel loops, and a large cyst with echo-free contents near the pancreas, a diagnosis of large bowel obstruction with a paraduodenal cyst was considered. The findings were confirmed after postnatal ultrasonography. At the time of surgery, it proved to be a completely duplicated large bowel with a paraduodenal cyst. Prenatal findings of a hugely dilated, hyperperistaltic large bowel should lead one to suspect/consider large bowel duplication. Associated cysts are likely to be bowel duplication cysts. Timely intervention can thus obviate potentially serious complications.

Large Bowel Obstruction Associated with Renal Hypernephroma: A Case Report

A 40-year old Flight Sergeant in the Royal Air Force, previously fit apart from an appendicectomy 19 years before, was admitted on 15 September 1971 with a five-day history of lower abdominal pain, absolute constipation and no passage of flatus for 3 days, plus retching and vomiting for 24 hours. He was anorexic and had lost half a stone in weight in the previous two weeks. He was colour blind for red/green, so although he had noted ' dark' urine in preceeding days he did not complain of haematuria. His bowel function had previously been regular. On examination he was jaundiced and ill, with a generally tender abdomen containing a large tender mass in the left upper quadrant which moved with respiration. This mass was dull in the flank but resonant more medially and spread as far as the midline. It was not notched. There was no shifting dullness, and no other abnormal findings. The abdomen was not distended, occasional bowel sounds were heard. Rectal examination was normal and no faeces were felt. His left testis and cord were tender. A diagnosis of large bowel obstruction was made, an intravenous infusion and nasogastric suction was instituted and an enema administered (with very little result). Straight abdominal X-ray showed fluid levels and a soft tissue mass in the upper left quadrant (Fig. 1). After initial resuscitation an infusion pyelogram (LV.P.) was performed (Fig. 2) which showed a large mass at the lower pole of the left kidney with displacement of the left ureter. A barium enema showed an extrinsic mass compressing the descending colon (Fig. 3). A Foley catheter was passed for he had difficulty in initiating micturitation. The urine contained blood. The following laboratory results were obtained: