What are the criteria for urgent referral to a surgeon for a patient with large bowel obstruction?

Urgent referral to a surgeon for a patient presenting with large bowel obstruction is indicated when the obstruction is acute and potentially curative treatment is suitable. Specifically, people presenting with acute left-sided large bowel obstruction should be offered either stenting or emergency surgery if they are suitable for potentially curative treatment. This implies an urgent surgical assessment is required in such cases. Additionally, symptoms such as colicky abdominal pain, absolute constipation (no passage of flatus or stool), vomiting, or abdominal distention suggest intestinal obstruction and warrant same-day hospital assessment and surgical referral. These clinical features indicate complicated disease requiring urgent intervention.

Therefore, the criteria for urgent referral include:

• Presentation with acute large bowel obstruction, especially left-sided, where curative treatment is possible.
• Clinical signs of intestinal obstruction such as colicky abdominal pain, absolute constipation, vomiting, and abdominal distention.
• Signs suggestive of complicated disease such as abdominal rigidity, guarding, or sepsis, which may indicate perforation or peritonitis and require emergency surgical evaluation.

In summary, any patient with suspected acute large bowel obstruction presenting with these clinical features should be referred urgently to a surgeon for assessment and management.

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