Large Bowel Obstruction
12 results
1 - 12
Benign Disease- A 43-year-old morbidly obese man is undergoing a Hartmann procedure for Hinchey IV perforated diverticulitis. Two days postoperatively, the ostomy has retracted below the skin and appears purple. The patient remains afebrile and hemodynamically normal without peritonitis. Intubation of the colostomy with a test tube reveals black mucosa proximal to the fascia. What is the next step in management?
- A 75-year-old man presents with a 1-week history of progressive abdominal distention and a 2-day history of obstipation. He is afebrile and his vital signs are within normal limits. On examination, he has massive abdominal distention and there is tympany to percussion, but no signs of peritonitis. Computed tomography reveals a large bowel obstruction with a whirl sign on the left side of the abdomen. There are no signs of bowel ischemia or perforation. What is the best next step in management?
- A 37-year-old man with fibrostenotic ileal Crohn’s disease is taken to the operating room for ileocecectomy for treatment of chronic intermittent partial small bowel obstruction. Preoperatively, the patient has no evidence of colonic Crohn’s disease. Intraoperatively, the patient is found to have an ileosigmoid fistula. The sigmoid colon is otherwise without evidence of Crohn’s disease. The best next step in management of the sigmoid colon is:
- A 78-year-old woman comes to the emergency department with a long history of chronic constipation and obstipation, nausea, abdominal pain, and distention for the past 5 days. Physical examination reveals abdominal distention with bilateral lower abdominal discomfort and fullness. On digital rectal examination, fecal impaction is noted and an attempt at manual disimpaction is unsuccessful. Computed tomography shows the findings in the Figure. The best next step in management for this patient is:
- Malignancy
- A 46-year-old woman who underwent restorative proctocolectomy 5 years ago for a history of familial adenomatous polyposis is admitted for persistent abdominal pain of 3 months’ duration, nausea, vomiting, and progressive distention of her abdomen. She typically has 4 to 6 bowel movements per day but has recently been having only 1 to 2 watery bowel movements. Computed tomography of the abdomen demonstrates dilated loops of proximal bowel with air fluid levels. There is also a 10×10–cm mass at the root of the small-bowel mesentery near a clear transition point with decompressed distal small bowel. Nasogastric tube decompression has started. Which of the following is the most appropriate management strategy?
- You are consulted by the emergency department about a patient with a large bowel obstruction caused by an obstructing right colonic mass. On exploration, you note that she has peritoneal carcinomatosis in the right lower quadrant, with a normal-appearing liver and ovaries. You perform a right colectomy with primary anastomosis, and a biopsy of her metastatic disease. Final pathology report is consistent with metastatic appendiceal mucinous neoplasm. Staging shows no evidence of distant metastatic disease aside from her known isolated peritoneal lesions. What is the best treatment option to improve her overall survival?
- A 74-year-old woman presents with a 2-week history of obstipation and a nearly obstructing cancer of the distal sigmoid. Computed tomography of the chest, abdomen, and pelvis also shows evidence of extensive lung and liver metastases. What is the best initial treatment option for this patient?
- A 62-year-old man with abdominal pain and distention presents to the emergency room. Computed tomography of the abdomen and pelvis demonstrates an obstructing mass in the upper sigmoid colon with a single right hepatic metastatic lesion. The cecum measures 8 cm in diameter, and the small bowel is decompressed. What is the best next step in treatment?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Miscellaneous
- Perioperative
- Anorectal Disease