Large Bowel Obstructions

Large bowel obstructions (LBOs) are defined as a partial or complete interruption of the normal flow of the intraluminal contents of the colon. They represent an important cause of morbidity and mortality worldwide. LBO can be secondary to different colonic diseases. Among these, colorectal cancer (CRC) is responsible of approximately 60% of LBO, with the most common location being the sigmoid colon. Both acute and chronic LBO can occur. Clinical diagnosis is completed by imaging studies, which allow to identify the underlying causes. Computed tomography (CT) is the gold standard radiologic exploration for suspected LBO. Nasogastric tube placement and correction of electrolyte imbalances are the first step for LBO treatment. Inflammatory or functional diseases can be treated by medical therapy, whereas mechanical obstructions often require invasive procedures. In these latest situations, surgery represents the most frequent treatment, although endoscopy and interventional radiology can be applied in selected patients. In general, a multidisciplinary teamwork is pivotal to mitigate the risk of severe complications and long-term morbidity after LBO.