ABSTRACT
The causes of large bowel obstruction are obstructing carcinoma, volvulus, diverticular disease, paralytic ileus (colonic pseudo-obstruction, Ogilvie’s syndrome), and inflammatory bowel disease, including toxic megacolon. The need for a colostomy is explained and the stoma appropriately sited when obtaining the patient’s consent. Prophylactic antibiotics are commenced (e.g. intravenous cephalosporin and metronidazole), and a naso-gastric tube and a urinary catheter are passed. Surgical access is gained through a midline incision skirting the left side of the umbilicus. Haemostasis is ensured and thorough peritoneal lavage is carried out with at least 1–2 L of warmed normal saline. A drain may be left in the pelvis. An end colostomy is then fashioned using interrupted circumferential Vicryl sutures, and a stoma appliance is applied. Volvulus is a rotation of a segment of intestine about its own mesenteric axis. This leads to partial or complete obstruction of the lumen and dilatation.
