Management and Imaging of Large Bowel Obstruction

Large bowel obstruction represents a critical surgical emergency characterised by mechanical or functional blockage of the colon, most commonly due to colorectal carcinoma, volvulus or diverticular strictures. Patients typically present with abdominal distension, crampy pain, constipation and vomiting. Initial management centres on prompt fluid resuscitation, correction of electrolyte imbalances and nasogastric decompression. Imaging is indispensable: plain abdominal radiographs may reveal haustral patterns, air–fluid levels and free gas, but computed tomography (CT) has become the cornerstone for identifying transition points, underlying lesions and signs of bowel wall ischaemia. CT colonography and magnetic resonance imaging (MRI) contribute further detail in equivocal cases or preoperative planning. Endoscopic decompression techniques, including colonoscopic stenting, may obviate emergency laparotomy in selected malignant obstructions, while surgical strategies range from segmental resection with primary anastomosis to Hartmann’s procedure or defunctioning stoma. In frail or palliative patients, minimally invasive interventions and symptom‐focused care assume priority. Multidisciplinary coordination among surgeons, interventional radiologists and palliative teams ensures tailored decision-making and optimisation of outcomes.

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Management and Imaging of Large Bowel Obstruction publication trend

The graph below shows the total number of articles in management and imaging of large bowel obstruction across all publications each year (not limited to Nature Index journals).

Technical terms

Large bowel obstruction: Mechanical or functional blockage of the colon preventing passage of intestinal contents.

Computed tomography (CT) colonography: Radiological technique using CT imaging and contrast-mediated luminal distension to visualise colonic anatomy.

Point-of-care ultrasound (POCUS): Bedside ultrasonography performed by the clinician to rapidly assess abdominal organs and detect obstruction.

Endoscopic decompression: Non-operative relief of obstruction using colonoscopic stent insertion or balloon dilatation.

Defunctioning stoma: Surgically created external diversion of faecal stream to reduce pressure on a diseased bowel segment.

References

1. ESR Essentials: Imaging in colorectal cancer—practice recommendations by ESGAR. European Radiology (2024).
2. Palliative Treatment of Bowel Obstruction With Colostomy Under Local Anesthesia in Frail Patients: A Single-Site Experience. Cureus (2023).
3. Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report. Cureus (2022).