Large Bowel Obstruction: Emergency Care, Clinical Response, and Acute Hospital Management Perspectives
Abstract
Background: Large bowel obstruction (LBO) is a critical surgical emergency characterized by the cessation of normal colonic transit, leading to rapid physiological decompensation. It is a common initial presentation of advanced colorectal cancer and can also arise from benign causes like volvulus, diverticulitis, or pseudo-obstruction.
Aim: This comprehensive review aims to detail the etiology, pathophysiology, clinical evaluation, and contemporary management strategies for LBO, emphasizing the integration of emergency care, diagnostic imaging, and multidisciplinary treatment.
Methods: A narrative synthesis of current literature was conducted, analyzing diagnostic approaches (including CT imaging and endoscopy) and evidence-based interventions. The review evaluates guidelines and recent clinical trials comparing endoscopic, radiologic, and surgical management.
Results: Initial management prioritizes aggressive fluid resuscitation and electrolyte correction. CT imaging is the diagnostic cornerstone. For malignant LBO, self-expanding metal stenting has emerged as an effective bridge-to-surgery, reducing stoma rates and enabling elective single-stage resection with similar long-term oncologic outcomes to emergency surgery. Surgery remains definitive for many cases, with approach (single vs. multi-stage) tailored to patient physiology and disease characteristics. Specific etiologies like sigmoid volvulus require endoscopic decompression, while acute colonic pseudo-obstruction is managed with neostigmine.
Conclusion: Successful LBO management requires timely diagnosis, hemodynamic stabilization, and an etiology-driven intervention strategy. A coordinated, interprofessional approach optimizes outcomes by integrating endoscopic, radiologic, and surgical expertise to reduce morbidity and mortality.
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References
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Copyright (c) 2025 Turki Mohammad Hasssan Almalki, Bassam Alrimthi Alanazi, Mohammed Owaid Mutlaq Alanazi, Hamed Mohammed Almolhis, Turki Saleh Abdulfattah Alamri, Abdullah Rabie Mohammed Alsahli, Saleh Muteb Nafea Albadrani, Basem Saud Ahmed Farhan, Mohammed Ghazi Alhejili, Mohammad Nasser Hamdan Al Aftan
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