Imaging of Uncommon Causes of Large-Bowel Obstruction

Abstract

We propose an algorithmic approach to the radiologic evaluation of the uncommon causes of LBO.

Imaging of Constipation and Its Complications

“…CT has a reported sensitivity of 96% and specificity of 93% in the identification of constipation. Additional benefits of CT are visualization of complications associated with constipation, particularly stercoral colitis, ischemia, and perforation, and other organ systems for comorbid conditions that may cause constipation [1,3,[13][14][15]. CT is widely used to image adult patients however it is used judiciously in pediatric patients to avoid radiation exposure.…”

“…CT may display ancillary features of the primary cause of the stricture that may lead to an accurate diagnosis [17]. If the patient has colonic diverticular disease, repeated episodes of diverticulitis may cause a stricture (Figure 13) [15,18].…”

“…Multiple and prolonged episodes of inflammation Crohn disease and ulcerative colitis are types of inflammatory bowel disease that may cause a fixed stricture (Figure 14) [15,19]. Surgical and treatment history may reveal that the fixed stenosis is likely due to adhesive fibrosis from a surgical anastomosis or ( Figure 15A and B) [15].…”

“…CT plays an invaluable role in the detection of a significant and even fatal complication of constipation that is known as stercoral colitis. Elderly patients, especially those with chronic diseases, are at the highest risk for development of stercoral colitis [3,[13][14][15]. Signs and symptoms of stercoral colitis are not specific; however, the most common complaints are constipation and pain [3,13,14].…”

“…Radiography can detect fecal impaction and fecalomas in the colon and rectum however provides no sensitive or specific findings of stercoral colitis [3,13,14]. CT is diagnostic of stercoral colitis and its complications and can also exclude alternative causes of pain [3,[13][14][15]. The finding that is present in all patients with stercoral colitis is a fecaloma (Figure 16A and B) [3,[13][14][15].…”