title: Management and causes of acute large-bowel obstruction.
abstract: Acute LBO has many possible causes. In the United States, the most common cause is colorectal carcinoma. Mechanical obstruction should be differentiated from pseudo-obstruction by contrast enema or colonoscopy because the treatments differ. The high postoperative mortality and morbidity of LBO compared with elective resection are explained by the multiple associated pathophysiologic changes of obstruction. Management of this condition requires careful assessment, awareness, and expertise in the current modalities of treatment. Gangrene and perforation should be avoided because they limit treatment options and are associated with an increase in mortality. We prefer, in most instances, to perform a single-stage procedure, which has the advantages of reduced hospital stay (and cost) and avoidance of a stoma. However, the appropriate treatment needs to be tailored to the individual situation. Recent developments in nonoperative decompressing procedures may demonstrate advantages in the future.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio, USA.
authors.forename: F
authors.initials: F
authors.lastname: Lopez-Kostner
authors.forename: G R
authors.initials: GR
authors.lastname: Hool
authors.forename: I C
authors.initials: IC
authors.lastname: Lavery
mesh_terms: D000208:Acute Disease; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D003113:Colonoscopy; D003287:Contrast Media; D017558:Elective Surgical Procedures; D004733:Enema; D005734:Gangrene / Q000517:prevention & control; D017721:Hospital Costs; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D007416:Intestinal Perforation / Q000517:prevention & control; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D007420:Intestine, Large / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D007902:Length of Stay; D011183:Postoperative Complications; D011859:Radiography; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D015996:Survival Rate; D014481:United States
chemical_list: D003287:Contrast Media