ASCRS Ch39 - Large Bowel Obstruction

Chapter 39, "Large Bowel Obstruction," ASCRS Textbook of Colon and Rectal Surgery, 4th edition. Authors: Daniel L. Feingold and Fergal J. Fleming. Book pp. 681–697 (title page through References).

Textbook reference chapter (not primary literature). A comprehensive treatment of large bowel obstruction (LBO) — pathophysiology, clinical presentation, imaging, and management by etiology (malignant, volvulus, acute colonic pseudo-obstruction, and a long tail of rare causes). Deepens three existing wiki pages substantially: Large Bowel Obstruction (malignant-LBO management detail, rare causes), Colonic Pseudo-Obstruction (Ogilvie Syndrome) (pharmacotherapy/ decompression/surgical detail), and Endoscopic Polypectomy, EMR & ESD's Colonic stenting section (named SEMS trials/meta-analyses). Also backs a new dedicated page, Volvulus, given the depth of sigmoid/cecal volvulus, cecal bascule, mobile cecum syndrome, and ileosigmoid knotting content — a topic the wiki previously covered only in passing.

Structure

• Pathophysiology, clinical presentation, initial management, imaging: closed-loop physiology, Laplace's law and cecal perforation risk, CT as the preferred imaging modality.
• Malignant LBO: perforation management by tumor location; left-sided colonic obstruction (staged vs. primary-resection approaches, on-table lavage, segmental vs. total colectomy, diverting loop ileostomy, ACPGBI audit); right-sided colonic obstruction; self-expanding metallic stents (SEMS) as a bridge to surgery — history, eight RCTs/one large meta-analysis, the CREST trial, covered vs. uncovered stents; obstructing rectal cancer; unresectable disease.
• Volvulus: general epidemiology/pathophysiology/risk factors; sigmoid volvulus (nonoperative detorsion, surgery, non-resectional alternatives incl. percutaneous endoscopic colopexy); cecal volvulus; cecal bascule; mobile cecum syndrome; ileosigmoid knotting.
• Acute colonic pseudo-obstruction (ACPO/Ogilvie syndrome): pathophysiology, diagnostic criteria, medical therapy (neostigmine, other pharmacologic agents), colonic decompression, surgical therapy.
• Rare causes of LBO: intussusception, hernia, infection (actinomycosis, tuberculosis, schistosomiasis/helminthic), endometriosis, other malignancies (ovarian, gastric, pancreatic, bladder, lymphoma).

Open items / gaps

• The named SEMS RCTs (Dutch Stent-In 2, Pirlet, Alcantara, CREST) and meta-analyses (Arezzo, Mashar) are cited here at the textbook/secondary level only — none independently ingested from primary literature. See Endoscopic Polypectomy, EMR & ESD's Open items.
• The chapter closes at book p. 697; Chapter 40 ("Lower GI Hemorrhage," Jafari MD, Bleier JIS) begins immediately after at p. 699 — not yet read/ingested.