Large bowel obstruction

Perforation occurs most commonly in the cecum, regardless of obstruction cause.

In sigmoid volvulus, as the sigmoid loop is usually thickened from recurrent episodes of volvulus, the cecum is again at greatest risk.

Risk of cecal perforation dramatically increases with dimensions on plain abdominal x-ray >10 to 12 cm.

Tenderness over the cecal area should alert the clinician to imminent perforation.

Frequent feature owing to bacterial translocation from the obstructed colon.

Severe sepsis and septic shock are likely to follow colonic perforation without surgical intervention.

Broad-spectrum antibiotics should be initiated after blood has been drawn for microbiologic culture.

Sepsis

Large bowel obstruction from all causes carries an appreciable mortality and morbidity owing to the nature of the disease process and the health of the patient groups affected.