Clinical features of large bowel obstruction

Adults present quite late with vomiting, weight loss and appetite loss. They may complain of colicky abdominal pain.

Signs include:

• succussion splash
• dehydration
• mass due to the tumour, either in the epigastrium or in the lymph nodes
• hepatomegaly:
  • caused by metastases in the liver
  • presents late as an uncomfortable or painful mass
    
• vomiting:
  • occurs relatively late
  • the vomitus is feculent

Note - continuous pain may indicate bowel ischaemia. Cessation of pain may be an indication of deterioration. A tender abdomen, guarding, and absent bowel sounds may indicate perforation (2)

Reference

1. Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].
2. Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018 Aug 13;13:36.