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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 critical sign indicating imminent caecal perforation and peritonitis. Follows Laplace's law as the tension in the wall is greatest where the diameter is maximal.
Large Bowel Obstruction |
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Type | Small Bowel | Large Bowel |
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Abdominal Pain | Early, colicky, central abdominal pain. | Not always colicky. |
Vomiting | Early, bilious, progresses to feculent due to bacterial overgrowth. | Occurs later. |
Constipation | Late. | Early; may pass diarrhea in partial obstruction. |
Abdominal Distension | Less if high obstruction; vomiting prevalent. | More severe if obstruction is lower. |
Abdominal Percussion | May be resonant. | May be resonant. |
Bowel Sounds | High-pitched tinkling. | Varied; often absent in severe obstruction. |
AXR | Central small bowel shows valvulae conniventes across width, distended centrally, many short fluid levels on erect film. | Peripheral large bowel shows haustra without full wall crossing, few loops, fewer long fluid levels, transverse diameter <10 cm. |
Causes | Post-surgical adhesions, herniae, volvulus, paralytic ileus, small bowel ischemia, old irradiation damage, Crohn's disease. | Colorectal cancer, sigmoid volvulus, diverticular disease. |