Epidemiology
Intestinal obstruction is a common surgical emergency. It accounts for up to 20% of admissions with acute abdominal pain. Of these patients, around 20% will have large bowel obstruction.[1]
Obstruction is also the most common indication for emergency surgery for colorectal cancer, comprising up to 80% of such emergencies.[5] Similarly, colonic malignancy is the most common cause of large bowel obstruction in adults; approximately 30% of colorectal cancer patients initially present to an emergency care setting.[3][5][6] See our topic Colorectal cancer.
In the US from 2002-2010 there were 3,351,152 reported cases of bowel obstruction; 1.9% of these were caused by colonic volvulus.[7] Rates of colonic volvulus increased by about 5% per year, whereas rates of sigmoid volvulus remained stable.[7] Colonic volvulus accounts for up to 15% of all large bowel obstructions in the US and western Europe.[2][8][9] Africa, South America, Russia, Eastern Europe, the Middle East, India and Brazil are referred to as the 'volvulus belt', as there is much higher incidence of colonic volvulus in these countries, where it represents 13% to 42% of all intestinal obstructions.[9][10][11][12]
Risk factors
This could include an abdominal or gynaecological malignancy.
Colorectal cancer is the most common cause of large bowel obstruction.[19] Risk factors for colorectal cancer include colorectal adenomas and polyps, inflammatory bowel disease, diabetes, older age, alcohol consumption, smoking, obesity and family history of bowel cancer are all risk factors for colorectal cancer, and consequently large bowel obstruction.[19] Ask about any signs and symptoms of an undiagnosed malignancy, such as rectal bleeding, recent weight loss, or a change in bowel habit. See Colorectal cancer.
Chronic diverticular disease may be a cause of strictures which can cause large bowel obstruction. See Diverticular disease.
A rare cause of large bowel obstruction.[20]
Examine hernial orifices to detect an obstruction secondary to an irreducible hernia; most commonly seen in small bowel obstruction. See our topic Small bowel obstruction.
Previous benign or malignant masses; pelvic abscess.
Endometriosis is a rare cause of bowel obstruction.
Diabetes is associated with a 30% higher risk of colorectal cancer.[19]
May predispose the patient to colonic volvulus or pseudo-obstruction.
Gut motility is altered in diabetes and is associated with autonomic dysfunction.
May predispose the patient to colonic volvulus; 30% to 80% of patients with caecal volvulus have a history of previous abdominal surgery.[21]
In particular, a previous colorectal resection has a low risk of anastomotic stricture, a rare cause of large bowel obstruction.
Megacolon from any cause may predispose the patient to colonic volvulus owing to the elongation of the colon on its mesentery.
Any condition that results in an elongated colon predisposes the patient to the development of colonic volvulus.
Typically these patients are constipated and may have abused laxatives in an attempt to improve their symptoms.
Prolonged constipation may lead to faecal impaction and subsequent obstruction and even stercoral perforation.[22]
May be a cause of strictures.
Consumption of red meat and processed meat has been associated with colorectal cancer.[19] Low dietary fibre contributes to constipation and may be associated with diverticular disease and its complications (e.g., stricture). Longstanding constipation is associated with faecal impaction and obstruction.
A high-fibre diet has been attributed to the high incidence of sigmoid volvulus in Africa.[10][11]
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