True and false large bowel obstruction.

摘要: Acute large bowel obstruction can be the result of mechanical causes (such as colorectal cancer) or motility disturbances, latter being termed colonic pseudo-obstruction. Whatever aetiology, pathophysiology has clinical significance. Changes in augmented by increased blood flow may play a role dissemination tumour cells and/or bacteria. Intravascular fluid depletion, especially shortly after intestinal decompression, important haemodynamic implications. The diagnosis is often confirmed on plain abdominal X-ray, but water-soluble contrast studies are distinguishing (which almost always requires an operation) from pseudo-obstruction usually managed without surgery). Mortality and morbidity reduced optimization patient's condition both before operation using intensive care facilities careful timing surgery. surgical management malignant best directed senior surgeon. For tumours up to including splenic flexure, extended right hemicolectomy advisable since it offers adequate removal allows immediate safe ileocolic anastomosis. More distal should resected if possible, there much recommend on-table irrigation anastomosis, although colostomy with mucous fistula Hartmann's procedure still have place. Endoscopic decompression enables definitive surgery undertaken electively several techniques evaluated. Non-operative reduction sigmoid volvulus rigid flexible endoscopy achieved high success rates, not recommended for caecal volvulus. Resection necessary prevent recurrence. closely related viability. Uncomplicated medically endoscopic decompression. It occurs association systemic medical conditions, which need treated vigorously. Surgery indicated signs impending frank perforation, non-operative measures fail.