الفهرس 
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Abstract
The incidence and prevalence of Acute large bowel obstruction have changed dramatically in the 20th century, which characterized by the decrease of its frequency due to early diagnosis and management of most surgical abdominal diseases.
Large bowel obstructionis representing up to 20% of total intestinal Obstruction conditions. While the Acute type is representing up to 25% of the large bowel obstruction. This occurs mainly in the left side.And the most common cause of the left sided acute large bowel obstruction is the colorectal carcinomas.
The overall mortality and morbidity of acute large bowel obstruction is substantial. Mortality rates ranges from 3% for simple obstruction to as much as 30% when there is a vascular compromise or perforation of the obstructed bowel, depending on the clinical setting and other related or unrelated co-morbidities.
There are a wide Varity of the etiology and frequency of the large bowel obstructionthroughout the world, depending on Sex, Age, family history, geographical distribution and race.
Most common causes of the large bowel obstruction are colorectal carcinomas, Diverticulitis, sigmoidal and cecual volvulus, pseudo- obstruction oligiria syndrome and intussuscepiton in both infants and adults.
The main presentations may vary in severity and order according to the underlying cause, but the typical symptoms and signs are acuteabdominal pain (80%), nausea/vomiting (60%),progressive distention with absolute constipation (60%) and other general systemic manifestations.
Early and proper diagnosis will cause further proper management,which depends on good and accurate analysis of the history of the illness combined with good clinical examination at time of presentation, with help of the wide range of the diagnostic measures such as radiological and endoscopic procedures (which could act both diagnostic and prognostic measures).
While the diagnosis of the cause of the Acute large bowel obstruction,or acute abdomen in general depends on the resources and available facilities provided in hospitals and medical care centers, which made the ways of management varies throughout the world, and the golden rule ”Open and See” is the real and most accurate diagnostic measure of the Acute large bowel obstruction especially in the 3rd world countries.
As in any Emergency condition the acute large bowel obstruction, acquires proper resuscitation measures and rapid trials to decompress the obstruction by non-operative conservative methods, or the minimal invasive methods or finally surgery. Proper resuscitation and further good early preoperative preparations decreases the complications as well as the prognosis of the treatment.
Management methods may vary according to the underlying cause of the obstruction, presentation and surgeon’s assessment and opinion. Asthe golden role of the urgent exploration and resection of the affected segment may be the main trend for most of surgeons. Except in special cases which may requirespecial other measures.
In colorectal carcinomas the main trend is Resection with or without anastomosis according to the pathology,patient’s condition and the severity of the disease.
In cases of volvulus the trend is mainly the endoscopic decompression as first choice of treatment. Then elective resection after proper preparation of the colon. In case of the failed decompression or complicated case such as (peritonitis,perforation,etc.) urgent surgical resection is performed.
In cases of complicated diverticulitis with acute bowel obstruction, managed in general as the colorectal carcinomas.
While the main trend to treat the Pseudo-obstruction, is conservative.Endoscopy becamea key intervention in the management of ACPO, which is refractory to medical management. With Placement of a decompression tube should be considered at the time of decompression colonoscopy. PEC may provide an alternative method of decompression in patients who will not tolerate general anesthesia. , colonoscopy and related interventions have a high success rate in treating ACPO, leaving surgery for the treatment of complicated ACPO
As for intussusceptions non operative methods is the trend for treatment such as hydrostatic reduction, air enema, leaving open surgery and laparoscopic to the unresolved cases on the conservative methods.
The management of acute left-sided colonic obstruction which is the main cause worldwide for acute large bowel obstruction.Still remains a challenge despite significant progress.The single procedure that makes the biggest difference is colonic stinting, either for palliation or as a bridge to surgery. In the palliation group, it allows patients, at the end of their life, to avoid the additional burden of a colostomy. In the bridge-to-surgery group, the colonic stent has reduced mortality and morbidity rate, has shortened the hospital and ITU stay, and has reduced the rate of colostomy formation. It has basically converted a complicated urgent colectomy into an elective one. We still need more information regarding the long-term outcome. However, as it has a small rate of failure and, more importantly, as it is not available everywhere, particularly after hours and during the weekends, other options of the surgical management of acute left-sided colonic obstruction remain relevant. There is still enough evidence to suggest that the majority of patients can be treated safely with one-stage resection and anastomosis. Subtotal colectomy and ICI are not proven to add any additional benefit. Subtotal colectomy is still very useful in cases of synchronous tumors or proximal bowel damage. Hartmann’s procedure should be reserved for high-risk patients. There are remaining grey areas but clinical decisions will often depend on the surgeon’s experience. More senior supervision is needed in the management of these patients. Simple colostomy has no role other than for palliation or use in very ill patients who would not survive any other procedure.