Malignant bowel obstruction: The modern approach of colorectal surgeon

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Pavlenko A N, Pavlov R V and Krestianinov S S

Saint-Petersburg State University, Russia

: J Liver Disease Transplant

Abstract

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Colorectal cancer is one of the most common malignancies in developed countries. Malignant large bowel obstruction occurs in up to 20% of patients with colorectal cancer and carries an appreciable morbidity and mortality. Malignant bowel obstruction is one of the severe complications associated with colorectal cancer. Treatments target both the resolution of obstruction and symptom management. Malignant large bowel obstruction most often is caused by primary or recurrent adenocarcinoma of the colon. In addition, extrinsic compression of the colon with resultant obstruction may occur as the result of pelvic malignancies. Non-operative interventional strategies to palliate luminal obstruction are achieved using endoscopic and interventional radiologic techniques. Colonic stents potentially offer effective palliation for patients with bowel obstruction attributable to incurable malignancy, and a ‘‘bridge to surgery’’ for those in whom emergency surgery would necessitate a stoma. The aim of stenting with self-expandable metal stents (SEMS) in an obstructed colon is to transform an emergency surgical case into an elective surgery case and restore bowel transit, thus reducing morbidity, mortality, and the need for an enterostomy. The surgical solution can decide between simple enterostomy and bowel resection based on their experience, the patient’s clinical condition, and intraoperative findings. Bowel resection could be performed using Hartmann’s procedure, on table irrigation, and primary anastomosis or subtotal colectomy compliance with oncological principles. We have a difficult question, what to do with bowel perforation as diagnosed by clinical exploration and complementary studies, associated conditions contraindicating general anaesthesia and or hemodynamic instability.

Biography

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