ASGE Annual GI Advanced Practice Provider Course (Virtual) - Onboarding (Day One) | March 2025-Radiology Studies Case 3-Large Bowel Obstruction

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This document is a medical case study focusing on large bowel obstruction (LBO), comparing the clinical aspects of diverticulitis versus colon cancer. The primary objectives include understanding LBO, its common causes, and distinguishing between diverticulitis and colon cancer in clinical presentations.<br /><br />Large bowel obstruction is predominantly caused by colon cancer, accounting for 60% of cases, particularly distal to the transverse colon. Other benign causes can include volvulus (15%-20%), hernias, adhesions, and benign strictures. Clinically, LBO is characterized by symptoms such as abdominal bloating, pain, and absence of bowel movements. Physical examination might reveal abdominal distension and tenderness.<br /><br />Diverticulitis typically presents with sudden and constant lower left quadrant abdominal pain, changes in bowel habits, and potentially fever, although a palpable mass is uncommon. Conversely, colon cancer symptoms generally arise from tumor growth and might include hematochezia, unexplained anemia, and weight loss, with masses also being rare.<br /><br />Radiological findings play a crucial role in diagnosing these conditions. For diverticulitis, CT scans may show localized bowel wall thickening, soft tissue density, and the presence of diverticula, potentially with an abscess. Colon cancer may appear as soft tissue density with wall thickening and narrowed lumen. Large bowel obstruction on a plain film might show a dilated colon (6 cm or more), possibly without air-fluid levels. A CT scan can reveal a transition point and thinning of the bowel wall with a collapsed distal segment.<br /><br />The document underlines the importance of developing proficiency in interpreting imaging studies. This involves understanding GI radiology terminology, thoroughly reading reports, reviewing imaging alongside specialists, and ongoing training. The detailed imaging descriptions provide a visual and practical guide for diagnosis.

Asset Subtitle

Joseph Vicari, MD, MBA, FASGE
Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

large bowel obstruction

diverticulitis

colon cancer

clinical presentations

radiological findings

abdominal pain

CT scan

GI radiology

diagnosis

imaging studies