0:01

Okay, so here is our patient with a

0:02

high grade colonic obstruction.

0:04

This patient actually has a history of prior

0:06

colon cancer that is status post-radiation, and

0:09

that was a radiation stricture in the pelvis.

0:11

But notice how dilated the colon is.

0:13

It is extremely dilated. Distally,

0:15

we have that very narrowed obstructing region of

0:19

radiation fibrosis, and this is a problem, right?

0:23

So the question I have for you is,

0:24

is this a closed loop obstruction?

0:27

The answer is yes.

0:28

All right.

0:29

Because the distal obstruction is at the

0:31

level of the stricture, of course, but

0:33

proximally, you have the ileocecal valve.

0:35

Frequently you can see the ileocecal valve

0:37

because they just have these little,

0:38

we call them fatty lips of the ileocecal valve.

0:41

That's where the terminal ileum comes into the secum.

0:43

But that can work as a one-way valve,

0:47

or I like to say a have a heart trap.

0:49

This is a little trap you can get if

0:50

you have a mouse infestation where the

0:52

mice can go in, but they can't come out.

0:54

That's a similar principle of the

0:56

ileocecal valve, the feces can get

0:59

through it, but can't come back.

1:00

So as a result, if you have a high grade

1:04

colonic obstruction, it is indeed a closed

1:07

loop obstruction because the contents of the

1:09

colon can't go pro-grade through the colon,

1:12

and they can't be drained retrograde either.

1:15

So this is actually an emergent situation, not

1:18

an urgent, not, um, you know, maybe tomorrow

1:21

morning this is a situation which is emergent.

1:25

You should definitely raise all of the flags

1:28

to your referring clinicians to know that

1:30

this is under tension and that there could

1:32

be a high likelihood of perforation here.

Large Bowel Colonic Obstruction

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video