From the Guidelines
The most appropriate investigation for this patient is option C, Colonoscopy, as it allows for direct visualization of the colon to identify potential obstructing lesions, strictures, or recurrent malignancy, and can also be therapeutic in some cases. This patient's presentation suggests possible bowel obstruction, which is a common complication following colorectal cancer surgery, as noted in the study by 1. Given his history of colon cancer, there is concern for anastomotic stricture or cancer recurrence causing the obstruction.
The patient's symptoms of abdominal pain, vomiting, and abdominal distension are consistent with a bowel obstruction, as described in the study by 1. The study by 1 also highlights the importance of considering organic obstruction, such as adhesion formation, in patients with a history of abdominal surgery. However, in this case, the primary concern is in the colon given the patient's surgical history, making Colonoscopy the most appropriate initial investigation.
Small bowel series would be less helpful as the primary concern is in the colon, and Barium enema is contraindicated in suspected obstruction as it may worsen the condition, as noted in the example answer. Laparotomy is too invasive as an initial diagnostic approach when less invasive options like Colonoscopy can provide valuable diagnostic information first. The study by 1 also emphasizes the importance of considering the patient's overall clinical presentation and medical history when determining the appropriate diagnostic approach.
Key points to consider in this patient's management include:
- The patient's history of colon cancer and previous abdominal surgery
- The symptoms of abdominal pain, vomiting, and abdominal distension
- The potential for anastomotic stricture or cancer recurrence
- The importance of direct visualization of the colon to identify potential obstructing lesions or strictures
- The potential therapeutic benefits of Colonoscopy in some cases.
From the Research
Diagnostic Approach for Small Bowel Obstruction
The patient's symptoms of abdominal pain, vomiting, and a distended but soft abdomen suggest a possible small bowel obstruction. The appropriate investigation for this condition can be determined based on the available evidence.
Imaging Modalities
- Computed Tomography (CT) is a powerful tool for assessing patients with small bowel obstruction, providing important information about the cause and site of obstruction, as well as the presence of complications such as ischemia 2, 3, 4.
- CT is recommended as the initial imaging modality for patients with suspected high-grade small bowel obstruction 5.
- Barium studies, such as a small bowel series, can be useful in diagnosing small bowel obstruction, especially in cases where the diagnosis is unclear or equivocal 6.
- Barium enemas and small-bowel examinations play a less significant role in the diagnosis of acute small bowel obstruction 5.
Recommended Investigation
Based on the evidence, the most appropriate investigation for this patient would be a CT scan, as it can provide valuable information about the cause and site of obstruction, as well as guide management decisions. However, among the given options, the closest to a CT scan is not available, but a small bowel series is mentioned, which can be useful in some cases.
Options
- A. Small bowel series: This can be a useful investigation in some cases of small bowel obstruction, especially when the diagnosis is unclear or equivocal 6.
- B. Barium enema: This is not the most appropriate investigation for small bowel obstruction, as it plays a less significant role in the diagnosis of acute SBO 5.
- C. Colonoscopy: This is not relevant to the diagnosis of small bowel obstruction.
- D. Laparotomy: This is a surgical procedure and not an investigation, although it may be necessary in some cases of small bowel obstruction, especially if there is evidence of ischemia or other complications 4.