Current management of large bowel obstruction: a narrative review

Abstract

Background and Objective: Large bowel obstruction (LBO) is a common colorectal surgical emergency. Symptoms and presentation may be subtle or profound. Causes can range from inflammatory to malignant. Historical approaches have been limited to surgery with stoma formation. With advances in procedural techniques, management has evolved and is tailored to disease specific strategies. The use of endoscopic stents and the highly selective use of stomas have greatly improved outcomes. The objective of this article is to provide a contemporaneous narrative review of the management of LBO. Methods: A literature search was conducted using PubMed/Medline, Embase and Google Scholar to identify relevant articles on the management of LBO. Society guidelines, systematic reviews and other narrative reviews were given preference. Studies on patients under 18 years, acute colonic pseudo-obstruction and slow colonic transit were not included. Key Content and Findings: This article contains a review of the aetiology, clinical presentation, diagnosis, and management of LBO. Conclusions: LBO maybe caused by a spectrum of conditions with various complexities. An in-depth and robust understanding of the aetiology and management options for LBO is imperative to providing the best care for patients presenting with this potentially life-threatening condition. This article provides an up-to-date narrative review of the management of the most common causes of LBO.