LARGE
BOWEL OBSTRUCTION
As in
small bowel obstruction, large bowel obstruction results in an accumulation of
intestinal contents, fluid, and gas proximal to the obstruction. Obstruction in
the large bowel can lead to severe dis-tention and perforation unless some gas
and fluid can flow back through the ileal valve. Large bowel obstruction, even
if complete, may be undramatic if the blood supply to the colon is not
disturbed. If the blood supply is cut off, however, intestinal strangulation
and necrosis (ie, tissue death) occur; this condition is life threatening. In
the large intestine, dehydration occurs more slowly than in the small intestine
because the colon can absorb its fluid contents and can dis-tend to a size
considerably beyond its normal full capacity.
Large
bowel obstruction differs clinically from small bowel ob-struction in that the
symptoms develop and progress relatively slowly. In patients with obstruction
in the sigmoid colon or the rectum, constipation may be the only symptom for
days. Even-tually, the abdomen becomes markedly distended, loops of large bowel
become visibly outlined through the abdominal wall, and the patient has crampy
lower abdominal pain. Finally, fecal vom-iting develops. Symptoms of shock may
occur.
Diagnosis
is based on symptoms and on x-ray studies. Abdominal x-ray studies (flat and
upright) show a distended colon. Barium studies are contraindicated.
A
colonoscopy may be performed to untwist and decompress the bowel. A cecostomy,
in which a surgical opening is made into the cecum, may be performed for
patients who are poor surgical risks and urgently need relief from the
obstruction. The proce-dure provides an outlet for releasing gas and a small
amount of drainage. A rectal tube may be used to decompress an area that is
lower in the bowel. The usual treatment, however, is surgical resection to
remove the obstructing lesion. A temporary or per-manent colostomy may be
necessary. An ileoanal anastomosis may be performed if it is necessary to
remove the entire large colon.
The
nurse’s role is to monitor the patient for symptoms that in-dicate that the
intestinal obstruction is worsening and to provide emotional support and
comfort. The nurse administers intra-venous fluids and electrolytes as
prescribed. If the patient’s con-dition does not respond to nonsurgical
treatment, the nurse prepares the patient for surgery. This preparation
includes pre-operative teaching as the patient’s condition indicates. After
surgery, general abdominal wound care and routine postopera-tive nursing care
are provided.
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