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Cause of the main causes of large bowel obstruction are the following: (a) cancer obstruction as the primary cause of bowel obstruction. Buechtor reported intestinal obstruction in 78% of total colonic obstruction, splenic flexure of the following cancers reported in the literature obstruction 72% to 88%. Tumor location: the left colon were more common 39%, in addition to the transverse colon were 27%, 19% right colon, rectum 15%. Common site of bowel obstruction were: sigmoid colon 38%, 14% of the splenic flexure, descending col0%, 9% of the transverse colon, rectum, 9%, 6% of the cecum, ascending colon 5%, 3% anal song. (B) of the colon torsion is the second common cause, can occur in the cecum, transverse colon and sigmoid colon, but the most common sigmoid colon. According to the U.S. and Western Europe Statistics: 1% ~ 7% of colonic obstruction caused by the colon torsion, in which the sigmoid colon 65% to 80%, right colon accounted for 15% to 30%, transverse colon and splenic flexure rare. Sigmoid colon with torsion often have the following three conditions. long sigmoid colon; contraction of sigmoid mesentery at the base; weight gain within the intestine (such as constipation, overeating) and external forces to promote the (strong peristalsis.) (C) of the colonic schistosomiasis endemic area of schistosomiasis in China, schistosomiasis granuloma or associated with colon cancer is still seen from time to time; the large number of schistosome eggs deposited in


the intestinal wall, repeated inflammation, damage and repair, to thicken the intestinal wall tissue , the formation of polyps, caused by intestinal stenosis and obstruction. (D) acute colonic pseudo obstruction (Ogilvie syndrome) disease from the Ogilvie in the United Kingdom in 1948, after many reports in recent years, there is a growing trend in the report of the disease. The exact cause of this disease is unknown, according to statistics from 1948 to literature in 1980, 88% were caused by reasons other than the colon, such as surgery, trauma, heart failure, uremia, diabetes, ischemic colitis, metastatic tumors, such as hypoxia and hypotension and 12% for unknown reasons. No perforation was 25% mortality rate to 31%, with perforation of 43% to 46%. Fariano that the sacral parasympathetic nerve disease and related disorders. Matsui reported that causes dysfunction of the nerve conduction disease, and in the microscope, the number of intramural ganglion cells decrease in nerve cell degeneration. Bode pathogenesis of 22 cases reported to surgery. (E) pelvic junction obstruction caused by postoperative adhesion characteristics of this disease are: mostly occurs in middle-aged women after pelvic surgery; intermittent abdominal distension, chronic abdominal pain and constipation; no special disease barium enema; colonoscopy angle of the sigmoid colon was seen, there are narrow, to prevent access to colonoscopy. (F) outside the colon obstruction caused by tumor compression or violations, such as pancreatic or gastric cancer invading the transverse colon causing obstruction; female pelvic tumors, particularly ovarian tumor compression caused by obstruction of the sigmoid colon is not uncommon. (Vii) all gallstone intestinal obstruction accounts for 1% to 3%, 15% rate of preoperative diagnosis (13% to 48%), gallstone into the digestive tract ways: gallbladder - fistula second (more common); gallbladder - colonic fistula; gallbladder - gastric fistula; common bile duct, duodenal fistula. Individual cases, gallstones can be passed directly into the duodenal ampulla expansion. Pathological colonic obstruction, due to the ileocecal valve closed, intestinal contents can enter can not form a closed loop type of obstruction, the colon than the small intestine rich blood supply, combined with thin-walled, even simple obstruction is also prone to partial necrosis and perforation. High levels of bacteria in the colon, obstruction bacteria to speed up, easy to lead to systemic infection. Deitch study shows that: intestinal obstruction after 6h, 24h after the bacteria enter the mesenteric lymph nodes into the liver, spleen and blood flow in late intestinal obstruction tended to increase blood flow, which makes a lot of bacteria and toxins to be sucked into the blood circulation and increase the systemic symptoms of poisoning, and even toxic shock. Cancer depends on the severity of obstruction extent of tumor invasion, incomplete intestinal obstruction, its clinical and pathophysiological changes are not serious, complete obstruction, there are severe flatulence, excessive expansion of the bowel wall changes thin, reduced blood supply, so easy to necrotic perforation. Volvulus formation of intestinal obstruction, but also not entirely the point completely. Incomplete when the inner product of intestinal gas and fluid loops exist; complete obstruction more acute torsion, is a closed loop of obstruction. The swallow has been truncated origin gas, intestinal loops for multi-product gas within the fluid, the intestinal segment height of expansion, much higher than for the thick bowel obstruction above, this section is the excessive expansion of the intestine, can cause the tension of the intestinal wall damage, coupled with mesenteric vascular disorders of the blood supply has occurred, the result of intestinal loops hemorrhage, necrosis, exudate, or even perforation. Acute colonic pseudo obstruction, colon flatulence obvious necrosis perforation is not uncommon, but most can be cured by non-surgical. Diagnosis of bowel obstruction can occur in any part of the colon, but the left colon is more. Cancer, chronic obstructive colonic obstruction is often typical performance, such as constipation, diarrhea, pus and blood will, and changes in bowel habit and shape history; the right half of abdominal pain, bowel obstruction, and in the right upper abdomen, left many in the left lower quadrant abdominal pain, obstruction . Chronic obstruction may be gradual or sudden development of acute obstruction. Beal made: the elderly had progressive abdominal distension and constipation are typical colon obstruction. Normal 10% to 20% ileocecal valve dysfunction, part of the colon contents into the ileum can be returned to the small intestine caused by expansion of product gas, liquid junction, often misdiagnosed as low small bowel obstruction. If the ileocecal valve function was good and the site of obstruction ileocecal closed loop between the intestines; this time, back to the intestinal gas, liquid continuously into the colon, the colon swelling, bloating significantly, the complete cessation of the exhaust and defecation, but still can be no vomiting. In addition to outside inspection, abdominal distension, visible or palpable mass intestinal, rectal examination should be performed and X-ray examination. Perspective in the abdomen or abdominal plain film shows significant obstruction of proximal intestinal loop expansion, no gas distal intestinal loop, orthostatic fluid level within the colon can be seen. Barium enema can help identify, at the same time to establish the location and cause of obstruction plays an important role. Buechter report abdominal X-ray and barium enema in the diagnosis rate was 97% and 94%. Sigmoid or reverse the past history of constipation often have multiple episodes of abdominal pain, the bowel movement, relief of symptoms after discharge. In addition to clinical manifestations of abdominal cramps, there are obvious abdominal distension, and vomiting usually is not obvious. Abdominal X-ray film shows "abnormal double-loop intestinal flatulence song was horseshoe-shaped, and almost fills the entire abdominal cavity." When in doubt, can be used for barium enema, the site of obstruction was "beak-like." The diagnosis of gallstone obstruction: more common in older obese women; in cholecystitis and cholelithiasis based on the incidence; with intestinal symptoms; X-ray performance: a. mechanical intestinal obstruction; b. ectopic stone (enteral There vagus calcification calculi); c. gas within the biliary tract. Diagnosis and treatment of colonic obstruction of difficulty, Stewest advocate the use of water-soluble placebo Diodone enema, he analyzed 117 cases of large bowel obstruction, the first group of abdominal X-ray diagnosis of 99 cases of mechanical large bowel obstruction, but clearly for the colon by enema Diodone Only 52 cases of obstruction; second diagnosis of colonic pseudo obstruction in 18 cases, 15 cases confirmed by Diodone enema, and the other 2 cases of colon cancer, and 1 check failed. He therefore believed that acute large bowel obstruction Diodone enema for diagnosis and treatment help to confirm whether due to mechanical intestinal obstruction, acute colonic pseudo obstruction and avoid surgery. Check 1, X-ray: increased colon and less flatulence stomach bubble liquid surface of intestinal continuity was arranged in curved lines disappear 2 extraperitoneal fat, blood tests: blood and blood examination to help understand whether the strangulation obstruction and water and electrolyte disorders treatment colon cancer obstruction, surgical treatment aims to remove the obstruction and cure cancer. For the right colon obstruction, most surgeons agreed with a subtotal resection and anastomosis. Of the left colon obstruction, more and more claims of one stage of the emergency subtotal resection and anastomosis. Matsui left colon obstruction in 153 cases concluded one stage subtotal resection and anastomosis, surgery may be considered a treatment of the obstruction and cancer, rapid postoperative recovery, lower mortality rate (10.45%), fewer complications (25.6) and non- sequelae and so on. To improve the success rate of surgery, and many of the enhanced preoperative bowel cleansing. Terasaka report 5 cases of the balloon with a long tube (240cm) obstruction caused by cancer treatment, will be sent to the site of obstruction balloon tube, 5 patients with a preoperative decompression effects are good, abdominal distention after decompression significantly improved, through the preoperative, intraoperative, in vacuum and washing, can greatly improve the success rate of surgery and reduce postoperative complications. He believes that the role of the tube are the following: preoperative, intraoperative bowel irrigation and decompression are feasible; change emergency surgery to elective surgery; feasible preoperative antibiotic bowel preparation; replaced by treatment of the partial resection; No proximal stoma and a safe anastomosis. However, a long tube into the hepatic flexure of the time its shortcomings. It has been reported, left colon obstruction in the intraoperative antegrade colonic lavage to remove the obstruction, and change the emergency to elective surgery with good results. Roots from the appendix into the cecum-Foley balloon catheter, the balloon inflated, the catheter is tightly enclosed appendix, and then injected via the catheter with normal saline 3000ml, 1000ml in the last Jia Ruka also kanamycin and 0.5% metronidazole 1g 200ml so that the proximal colon lumen clean, all the empty intestine lavage to remove the Foley catheter, remove the appendix. Through the above processing, not only to ensure a smooth cut, and avoid intraoperative contamination and postoperative infection. China reports 45 cases of rectal cancer a group of acute obstruction, only 14 cases of possible surgery, no operative mortality. 14 cases, 4 cases of emergency removal of a resection, resection of stage 2 cases, 8 cases of non-emergency surgery. A resection of 4 cases, 3 patients survived more than 5 years, stage resection in 2 patients were dead within 5 years, 8 cases of non-urgent surgery, 4 patients survived for 5 years. In short, whether acute or acute, should strive for a removal of the tumor, but in critically ill patients, effective treatment of cancer is still the obstruction of proximal colostomy. For those of unresectable or recurrent colorectal cancer caused by obstruction, in order to alleviate the suffering of patients, it was reported that Nd-YAG laser line with local tumor resection, short-term effect. Of bowel obstruction caused by a gallstone via colonoscopy stone, usually without surgery. Early non-surgical treatment to reverse sigmoid; Bruusguard first introduced in 1947 by sigmoidoscopy for colon Torsion anal plug, the success rate of 86%, 14.2% mortality, which opened up a disease-oriented therapeutic approach. Non-operative reduction surgery can reduce mortality, and elective surgery for a time, especially suitable for the elderly and infirm. However, due to concerns or worries caused by intestinal perforation caused by intestinal necrosis during surgery delayed until the 60's was widely adopted this law, received remarkable results. Still believe that, in the absence of intestinal stenosis should be inserted into the anal canal by sigmoidoscopy, the Ministry of the anal canal can be quickly discharged by twisting a large number of product gas and manure, you can reset itself to reverse, the symptoms can be quickly discharged, receive an immediate effect. The anal canal should be retained 2 ~ 3d, to prevent early recurrence. After reversing the lifting of 10d should be held in a sigmoid resection and anastomosis. In recent years, the sigmoid colon with colonoscopy to reverse the reset line of non-operative reduction compared to other high success rate, blindness, safe degree. It intubation by flexible sigmoidoscopy compared with the following advantages: small mirror tube, the patient easily tolerated; mirror body soft and easy to damage the intestinal wall; light strong, clear vision, mucosal edema can be observed; success rate reset high, sigmoidoscopy with colonoscopy reset reset failure may be successful; side can be almost entirely net absorption of gas in the colon, complete decompression, generally do not need anal retention. Surgical treatment: indications for exploratory laparotomy: The failure of non-operative reduction; There were signs of intestinal necrosis or peritonitis; When inserted mirror see a bloody manure within the intestine, or intestinal necrosis or ulceration. If the reverse merger necrosis, must be OK bowel resection surgery is safe for Hartmann, due to less complications and low mortality rates, and can have the full removal of necrotic bowel. A resection anastomosis applies only to reverse the expansion of the colon and intestinal edema, no significant cases. If the patient general condition is still good, no serious peritonitis, a good blood supply in the upstream bowel resection and anastomosis is safe. Ballantyne to reverse the summary of 2228 cases of sigmoid mortality, were 12.4% viable intestine, strangulated by 52.8%. Therefore, the sigmoid colon as early as possible to reverse the deal to avoid intestinal necrosis. Gallstone obstruction: <2.5cm stones often pass spontaneously by the intestine, 3cm in diameter stones can produce intestinal obstruction, was reported 24 cases of gallstone obstruction (stone diameter of 2 ~ 4cm), 23 underwent surgical treatment, 19 cases of intestinal fetching stones exploratory laparotomy in 13 cases, stones in the colon, a routine small bowel resection. Only 1 case of self-discharge. Acute colonic pseudo obstruction, in the past and more with conservative treatment, such as decompression, correction fluid and electrolyte imbalance, such as resistance to infection and anal exhaust, if necessary, make the line appendix surgery. Many of the reports at home and abroad in recent years with colonoscopy to treat the disease successfully. Some people believe that colon bowel preparation is not feasible line colonoscopy, just 1h before the test with 1L water enema, fecal residue out to check inflation as little as possible, do not blindly intubation. If an inspection found that intestinal ischemia or bleeding should stop checking conversion operation, to avoid perforation. Gosche summarizes the 9 groups were 169 cases of decompression colonoscopy 209 times, the first decompression averaged 85% success rate, recurrence rate of 25% and mortality 2%, the need for surgical decompression accounted for 13%. Surgical indication of acute colonic pseudo obstruction: signs of intestinal necrosis and peritonitis; cecal diam 9cm or 12cm are due to easily perforated; failure of conservative treatment; severe breathing problems; those diagnosed with doubt. Cecum and colon diameter of the timing of decompression and death are directly related. There is a set of data showed that when the cecal diam 14cm, its death, perforation rate was 23%, mortality rate was 14%; and diameter <14cm, its necrosis, perforation and mortality rate was 7%. 7d after the onset of the colon by more parties, their mortality rate after the onset of 4d 5 times higher than in surgery. When colonic necrosis or perforation of the line emergency surgery, the mortality rate of 10% to 50%. Therefore, early diagnosis, timely decompression, can reduce mortality. In short, the treatment of bowel obstruction varied selection of ways in which patients should be based on general and local circumstances, there is no fixed procedure, and each person's experience and methods of dealing with patients is not the same. Therefore, in conjunction with its own conditions, considering, in order to best effect. Create the conditions for a colon resection and anastomosis is the treatment of obstruction of today's trends. Clinical manifestations The clinical manifestations of bowel obstruction small bowel obstruction was similar in general, clinical manifestations, has the following characteristics: All patients had abdominal pain, bowel obstruction were located in the right half of right upper quadrant, left many in the left lower abdomen, chronic abdominal pain, mild obstruction, acute obstruction severe abdominal pain, but not as good as volvulus, intussusception, as violent; nausea, vomiting appeared later, or even absent. Late yellow vomit fecal contents, evil smell; abdominal distension was small bowel obstruction, both sides of the abdomen prominent, sometimes horseshoe; stop defecation and anal exhaust, but most patients still have a small amount of gas in early obstruction discharge; examination see significant abdominal distension, can significantly horseshoe, was drum percussion sound, auscultation sound could be heard over the water gas. X-ray examination showed colon was fluid, product gas, and fluid levels. In short, to reverse the bowel obstruction than colon, its clinical presentation is not typical of small bowel obstruction, serious.


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