Large Bowel Obstruction
In the United States, the most frequent causes of large bowel obstruction, in decreasing order, include colorectal cancer, diverticulitis (or other inflammatory disorders such as inflammatory bowel disease (IBD)), sigmoid or cecal volvulus, fecal impaction, and then a number of other uncommon causes such as foreign bodies, sliding inguinal hernias, and endometriosis. In children, Hirschsprung’s disease, imperforate anus, and meconium ileus are common causes. Finally, colonic pseudo-obstruction should be included in the differential as it has a similar radiologic appearance, namely, proximal colonic distention and a paucity of distal gas. The key to differentiating amongst these is a thorough history and physical and a stepwise approach to ordering additional diagnostic tests, which include both imaging and endoscopic evaluations.