Colon obstruction

Pulmonary disease is characterized by thick mucus secretions, impaired mucus clearance, chronic airway infection and colonization, obstruction, and an exaggerated neutrophil-dominated inflammatory response. 

Obstructing disorders Pyloric obstruction Small bowel obstruction Colonic obstruction Achalasia... 

In the patient presenting with a recent onset of constipation, an obstructing lesion of the colon should be sought. In addition to a colonic neoplasm, other causes of colonic obstruction include strictures due to colonic ischemia, diverticular disease, or inflammatory bowel disease foreign bodies or anal strictures. Anal sphincter spasm due to painful hemorrhoids or fissures also may inhibit the desire to evacuate. 

Fig. 14.1. (A) Implantation of HT-29LP tumor cells into the posterior wall of the rectum. The anterior wall of the anorectal area is cut 7 mm in length between two hemostats to prevent colonic obstruction, resulting from tumor progression. Tumor cells are then injected submucosally using a 27 G needle. (B) At the end of the study period, the abdominal cavity is exposed through a midline incision and para-aortic lymph nodes (arrow), located around the abdominal aorta, are removed and imaged ex vivo.

The anorectal wall is cut 7 mm in length between the two hemostats to prevent colonic obstruction, resulting from rectal tumor progression (Fig. 14.1 A). 

Oral barium sulfate is theoretically non-toxic, but constipation and abdominal pain are not uncommon after barium meals or barium enemas (1). The main risk is that collections of barium wiU remain in the colon they can persist for 6 weeks or longer in elderly patients or cases of colonic obstruction barium fecoliths may even have to be removed surgically. Prolonged stasis of barium can occur after a barium enema into the distal loop of a colostomy. Residues in the appendix have caused appendicitis. Toxic dilatation of the colon can be aggravated by barium sulfate. 

The most common cause of colonic obstruction is carcinoma, either primary or metastatic, whereas the most common cause of small bowel obstruction is adhesions therefore, it is necessary to differentiate colonic obstruction from small bowel obstruction. Radiographs of the abdomen may be useful for the diagnosis of colonic obstruction in 60-70% of cases (Gore and Eisenberg 1994). Once colonic obstruction is suspected, contrast enema, is indicated to confirm the obstruction and to determine its level, severity, and cause (Amberg 1994). In the CT era, multidetector row CT examination is the best method for the evaluation of patients with acute abdomen including colon obstruction (Sinha and Verma 2005b Patak et al. 2005). 

Fig. 4.8a,b. Transverse colon obstruction due to adenocarcinoma, a Transverse sonogram of the right upper abdomen discloses circumferential thickening of the wall of the transverse colon (arrows) and fluid-filled dilated proximal colon, b CT image shows encircling thickening of the wall of the transverse colon (arrow) due to adenocarcinoma and dilated ascending and transverse colon... 

Lim JH, Ko YT, Lee DH et al (1994a) Determining the site and causes of colonic obstruction with sonography. Am J Roentgenol 163 1113-1117... 

Unlike treatment in the oesophagus and biliary tree, the treatment of gastroduodenal and colonic obstruction is not yet as well established. This is probably most likely due to the limited familiarity with the indications and available devices. 

In some recent publications from Korea custom made flexible covered metallic stents were advocated for gastroduodenal as well as colonic obstruction. Modified Z-stents were covered with a polyurethane membrane and stent shapes were further changed to improve flexibility and fixation (Choo et al. 1998 Jung et al. 2000 Park et al. 1999, 2001 Lee et al. 2001). 

The diagnosis of acute colonic obstruction is made by plain film radiography (Fig. 3.8a). An enema with water-soluble contrast medium and/or colonoscopy with biopsy are then performed to determine the... 

Baron TH, Dean PA, Yates MR, Canon CH, Koehler RE (1998) Expandable metal stents for the treatment of colonic obstruction techniques and outcomes. Gastrointest Endosc 47 277-286... 

Maynar M, Ferral H, Wholey M, Castaneda-Zuniga WR (1997) Treatment of malignant colonic obstruction with metallic stents the Tejero-Mainar procedure. J Vase Interv Radiol 8 139 141... 

Stone JM, Bloom RJ (1989) Transendoscopic balloon dilatation of complete colonic obstruction. Dis Colon Rectum... 

---