History

History focuses initially on the failure to pass stools or gas. One should attempt to distinguish complete bowel obstruction from partial obstruction, which is associated with passage of some gas or stools, and from ileus. Further historical questioning may be directed at the patient’s current and past history in an attempt to determine the most likely cause.

Complete obstruction is characterized by the failure to pass either stools or flatus and the presence of an empty rectal vault upon rectal examination, unless the obstruction is in the rectum.

Partial obstruction, in which the patient appears obstipated but continues to pass some gas or stools, is a less urgent condition. Distinguishing colonic ileus from organic obstruction is important. Ileus may be suggested by abdominal pain as a dominant feature of the clinical presentation, by peritoneal signs, or by the presence of pronounced fever and leukocytosis.

History of chronic weight loss and passage of maelanotic bloody stool suggests neoplastic obstruction.

Conversely, a history of recurrent left lower quadrant abdominal pain over several years is more consistent with diverticulitis, a diverticular stricture, or similar problems.

A history of aortic surgery suggests the possibility of an ischaemic stricture.