Management of Acute Large Bowel Obstruction in Elderly Patients

People worldwide are living longer. Conventionally, “elderly” has been defined as a chronological age of 65 years old or older, subjects from 65 through 74 years old are referred to as “early elderly” and those over 75 years old as “late elderly”. Large bowel obstruction (LBO) in the elderly patient is a common, frequent, and serious surgical emergency. Morbidity and mortality from acute intestinal obstruction have been decreasing over the past several decades. Nevertheless, bowel obstructions account for approximately 1–3% of all hospitalizations and 20% of cases need acute medical and surgical care. Large bowel obstructions are four to five times less frequent than small bowel obstructions (SBOs) and compromise only 10–15% of all intestinal obstructions. Large bowel obstructions are similar in incidence in both males and females. Colonic obstruction is most commonly seen in the sigmoid colon. Bowel obstruction can be mechanical or functional. LBO occurs when the lumen of the bowel becomes partially, completely blocked or closed-loop. Obstruction causes an increase in intraluminal pressure, damage of the blood flow in the parietal vessel, distension of the colon proximal to the transition point, and the collapse of the distal colon leading to mucosal edema, bowel ischemia, bowel infarction, and perforation. If left untreated the outlook is very poor (Lopez-Kostner et al, Surg Clin North Am. 77(6):1265-1290, 1997; Sawai, Clin Colon Rectal Surg. 25(4):200-203, 2012; Taourel et al, Abdom Imaging. 28(2):267-275, 2003).