A 62 year old male presents to the ED with 1 week of abdominal distension with associated nausea and vomiting. He has had only 2 small bowel movements in the last week. He denies abdominal pain. On exam, his abdomen is distended and rigid. An obstruction series is obtained and shown below. What’s the diagnosis?
![](https://emdaily.cooperhealth.org/wp-content/uploads/2023/12/image-2.png)
Answer: multiple air-fluid levels concerning for obstruction
- CT A/P obtained (shown below) – diagnosis of Large bowel obstruction
- Most common cause of large bowel obstruction = neoplasm/mass
- Other causes: diverticulitis, sigmoid or cecal volvulus
- Other uncommon causes: adhesions, hernias, IBS, fecal impaction, intraluminal FB, intussusception
- LBO are less common than SBO
- Presenting sypmtoms: abdominal pain/distension, constipation
- CT A/P w/ IV contrast is imaging modality of choice
- Most require surgery
- Ogilvie Syndrome: acute colonic psuedo-obstruction due to loss of sympathetic innervation of colon (no actual mechanical obstruction)
- Usually seen in severely ill patients with multiple comorbidities
- CT shows marked dilatation of the large bowel without any evidence of a marked transition point or obstructing lesion
![](https://emdaily.cooperhealth.org/wp-content/uploads/2023/12/image-3.png)
References:
Jaffe T, Thompson WM. Large-Bowel Obstruction in the Adult: Classic radiographic and CT findings, etiology and mimics. Radiology. 2015 June;275(3):651-63.
Price TG, Orthober RJ. Bowel Obstruction. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 538-41