Improved Outcomes in Colon and Rectal Surgery part 12. Written by many of the worlds leading colorectal surgeons, this evidence-based text investigates the risks and benefits of colorectal surgeries. By using clinical pathways, algorithms, and case discussions, the authors identify the best practices for patient safety and positive outcomes to ensure that physicians correctly recognize potential problems and carefully manage complications | improved outcomes in colon and rectal surgery Figure Small Bowel Obstruction. Plain radiograph demonstrates dilated loops of small bowel with absence of colonic gas indicating a complete high grade small bowel obstruction. There is air in the right inguinal canal. This patient had a surgery proven incarcerated right inguinal hernia. levels and absence of colonic gas indicate a complete high grade small bowel obstruction. SBO can be simple blood supply not impaired or strangulating blood supply impaired . Most strangulating obstructions are closed-loop obstructions blocked at both ends and this occurs typically with incarcerated hernias Figure and volvulus. 4 Plain films are not able to reliably differentiate simple from strangulating obstruction. However extensive mucosal thickening or edema portal venous gas or a closed loop obstruction indicates high risk for strangulating obstruction. 5 Large bowel obstructions LBO occur commonly in the sigmoid colon where stool is more formed and the colon is narrower. Air fluid levels distal to the hepatic flexure are strong evidence of obstruction unless the patient has had an enema. When the ileocecal valve is competent the small bowel usually contains little gas. When the ileocecal valve is incompetent Figure gaseous distention of the small bowel is often present as the colon decompresses into the ileum. 6 Toxic Megacolon Toxic megacolon is a manifestation of sever colitis with absent peristalsis and extreme dilation of all or a portions of the colon. A markedly dilated 6 cm colon with thumbprinting thickened mucosal folds projecting into the lumen caused by bowel wall edema is concerning for toxic megacolon Figure . Figure Large Bowel Obstruction. Supine radiograph demonstrates dilated colon as well as dilated small bowel in the right lower quadrant indicating a large bowel obstruction with incompetent ileocecal valve. Figure Toxic Megacolon. Plain radiograph demonstrates a markedly dilated .
