Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: Small Bowel Obstruction | Colonic (Large bowel) Obstruction | Caecal Volvulus | Small Bowel Ischemia | Hartmann's procedure | Sigmoid Volvulus | Acute Colonic Pseudo-obstruction |
🚨 RIF tenderness with radiological evidence of caecal distension and distal colonic obstruction is a red flag for imminent caecal perforation and peritonitis. This follows Laplace’s Law — the greatest wall tension occurs where the bowel diameter is largest (the caecum). ⚠️
| 🩺 Initial Management of Large Bowel Obstruction |
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| Feature | Small Bowel | Large Bowel |
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| Abdominal Pain | Early, colicky, central | Variable; may be dull or colicky |
| Vomiting | Early, bilious → faeculent | Late feature |
| Constipation | Late sign | Early & complete; overflow diarrhoea possible |
| Distension | More marked distally | Marked; especially sigmoid/caecum |
| Bowel Sounds | “Tinkling”, high-pitched | Varied; often absent if severe |
| AXR | Central loops, valvulae conniventes across full width | Peripheral, haustra not spanning full width |
| Common Causes | Adhesions, hernia, Crohn’s | Colorectal cancer, sigmoid volvulus, diverticular stricture |