Treatment of acute malignant colorectal obstruction with self-expandable metallic stents.

BACKGROUND: Malignant left-sided large bowel obstruction from intraluminal and extrinsic causes constitutes a surgical emergency. When conservative measures fail, emergent surgery is usually required, which carries increased morbidity and mortality compared with elective resections. In many situations, a stoma is created and further surgery may be required later to re-establish bowel continuity. We present an initial series of patients in whom self-expandable metallic stents (SEMS) were deployed to allow bowel decompression in place of emergency surgery for acute left-sided colorectal obstruction.

METHODS: From April 1999 to January 2001, patients who were admitted to the colorectal unit with clinical and radiological features of intestinal obstruction were considered for endolumenal stenting. Stenting was performed under radiological guidance.

RESULTS: Sixteen patients underwent endolumenal stenting (age range: 23-90 years, eight men and eight women). There were two technical failures, two delayed perforations and one sealed perforation related to the stent. Three patients underwent elective resection and anastomosis after successful bowel decompression and mechanical bowel preparation. Eight patients with advanced malignancy or multiple medical disease had good bowel decompression after stent deployment and did not undergo any surgery.

CONCLUSION: SEMS is a useful alternative in the management of acute left-sided colorectal obstruction for a select group of patients. An algorithm for management of acute left-sided large bowel obstruction incorporating the use of SEMS is proposed.