Acute Large Bowel Obstruction

Three hundred patients with large bowel obstruction were treated by emergency operation in a county, Veterans Administration, and community hospital population. Primary carcinoma of the colon, volvulus, and diverticulitis were the etiological factors in 84% of the patients. The combined hospital mortality of 37% was distributed as follows: county, 42%; VA, 40%; and community, 30%. Mortality from obstructing carcinoma was similar in all institutions. This was apparently related to the frequent insidious onset. In contrast, the community hospital had a decided edge in the successful management of volvulus and obstructing diverticulitis. The more dramatic onset of these two diseases prompted the private patient to seek medical consultation earlier.