Large Bowel Obstruction

Dr. Sulaiman Bin Yusof

MbChB (Sheffield) M.Med (Surg) FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士

Large bowel obstruction occurs when part of the colon becomes blocked, preventing the normal passage of stool and gas.

This blockage can lead to the build-up of intestinal contents, causing the bowel to dilate and potentially compromising blood flow to the intestinal wall. Without treatment, large bowel obstruction can result in serious complications, including bowel perforation and peritonitis.

Symptoms of Large Bowel Obstruction

Large bowel obstruction typically presents with symptoms that develop gradually over several days, reflecting the progressive nature of the condition.

Abdominal Pain: Patients experience cramping pain that comes and goes, usually centred in the lower abdomen.

Abdominal Distension: The abdomen becomes visibly swollen as gas and stool accumulate above the blockage, creating noticeable discomfort.

Changed Bowel Habits: Patients often notice a marked reduction or complete cessation of bowel movements and may find it increasingly difficult to pass gas.

Nausea and Vomiting: These symptoms, which typically occur in the later stages, result from a backup of intestinal contents behind the obstruction.

Causes and Risk Factors

Large bowel obstruction can develop from various conditions that narrow or block the colon.

  • Diverticular Disease

    Recurrent inflammation from diverticulitis can cause scarring and narrowing of the colon, creating a potential site for obstruction.

  • Colorectal Cancer

    Tumours growing within the colon wall gradually narrow the intestinal passage, eventually leading to obstruction.

  • Volvulus

    A segment of the colon twists on itself, cutting off both the passage of contents and the blood supply, which can result in severe complications.

  • Inflammatory Bowel Disease

    Prolonged inflammation, as seen in conditions like Crohn’s disease, can lead to the development of strictures that narrow the colon and obstruct bowel movements.

Types of Large Bowel Obstruction

Large bowel obstruction presents in different forms based on the nature and extent of the blockage.

Mechanical Obstruction

Results from physical blockage of the bowel lumen. The obstruction may be caused by masses within the bowel wall, external compression, or twisting of the bowel. This type typically requires surgical intervention.

Functional Obstruction

Occurs when the bowel loses its normal coordinated muscle contractions. This condition, also called colonic pseudo-obstruction, can result from nerve dysfunction, metabolic disorders, or certain medications.

Partial Obstruction

Allows some passage of intestinal contents past the point of obstruction. Patients may still pass small amounts of stool or gas. This condition may sometimes be managed conservatively while addressing the underlying cause.

Diagnostic Methods

Abdominal X-ray

An abdominal X-ray detects dilated bowel loops and air-fluid levels, common signs of an obstruction. It provides an initial assessment of bowel dilation and can sometimes identify the location and nature of the blockage.

CT Scan

A CT scan offers detailed cross-sectional images of the bowel wall and surrounding structures. It is necessary for determining the cause of the obstruction, such as tumours, volvulus, or strictures, as well as highlighting complications such as perforation or ischaemia.

Blood tests

Blood tests measure electrolyte levels, kidney function, and markers of infection or inflammation. These results help assess the condition’s severity, guide fluid replacement therapy, and identify potential systemic complications.

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Treatment Options

Non-Surgical Treatment
Bowel Rest

Halting oral intake temporarily allows the bowel to decompress and reduces strain on the affected area. During this period, patients receive intravenous fluids to maintain hydration and electrolyte replacement to correct imbalances caused by vomiting or reduced absorption.

Nasogastric Decompression

A flexible tube is inserted through the nose and advanced into the stomach to drain accumulated gas, fluid, and digestive contents. This reduces pressure within the bowel, alleviating discomfort and preventing further distension.

Medical Management

In cases of functional obstruction (where no physical blockage is present), treating the underlying cause can lead to resolution. For example, managing inflammation with medications or addressing an infection with antibiotics may restore normal bowel function.

Surgical Treatment
Resection and Anastomosis

This procedure involves removing the obstructed segment of the bowel and reconnecting the healthy ends to restore continuity. It is commonly performed for obstructions caused by colorectal cancer or other irreversible structural blockages.

Colostomy

In cases where direct reconnection of the bowel is not feasible, a colostomy is performed. This involves creating an opening (stoma) in the abdominal wall through which the colon is diverted to allow waste to exit the body. Depending on the underlying condition, the colostomy may be temporary, allowing the bowel to heal, or permanent if the affected segment cannot be restored.

Prevention and Management

Regular screening colonoscopies are required to detect and prevent diseases that can cause bowel obstruction, such as colorectal cancer. Patients with a history of diverticulitis or inflammatory bowel disease should maintain routine medical follow-ups and adhere to prescribed treatment plans to minimise risks. Individuals with prior abdominal surgeries should promptly seek medical attention if they experience symptoms suggestive of bowel obstruction.

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Dr. Sulaiman Bin Yusof

MbChB (Sheffield)

M.Med (Surgery)

FRCSEd (General Surgery)

蘇萊曼·尤索夫博士

Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.

Education & Specialist Training
  • MbChB(Sheffield)
  • M.Med(Surgery)
  • FRCSEd(General Surgery)

Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.

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    Frequently Asked Questions

    Can large bowel obstruction resolve on its own?

    In rare cases, a functional obstruction (pseudo-obstruction) may resolve without invasive treatment if the underlying cause, such as a medication or metabolic imbalance, is addressed. However, mechanical obstructions typically require medical or surgical intervention.

    Are there long-term effects after treatment for large bowel obstruction?

    The long-term effects depend on the cause and treatment. Surgical treatments like resection and colostomy may result in lifestyle adjustments, including dietary modifications or stoma care.

    Can large bowel obstruction recur after treatment?

    Recurrence depends on the underlying cause. For instance, obstructions caused by adhesions from previous surgery may recur. Regular monitoring and preventive measures tailored to the specific cause can help reduce recurrence risk.

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