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Clin Colon Rectal Surg 2022; 35(03): 197-203
DOI: 10.1055/s-0042-1742589
Review Article

Surgical Dilemmas Associated with Malignant Large Bowel Obstructions

David M. Schwartzberg
1   Mather Colorectal Surgery, Mather Hospital-Northwell Health, Port Jefferson, New York
,
Michael A. Valente
2   Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Abstract

Despite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing cancer. Malignant large bowel obstructions (MLBO) pose a challenging workup and treatment paradigm where an oncologic primary tumor resection must be balanced with relieving the obstruction, functional outcomes, palliation, and consideration for adjuvant therapy. A thorough work up with cross-sectional imaging and medical optimization should be attempted; however, patients may present in extremis and require emergent intervention. The onset of MLBO can be insidious, but result in electrolyte derangements, perforation, small bowel obstruction, hemorrhage, and ischemia. Self-expandable metallic stents have been used as palliation or as a bridge to surgery and have allowed for minimally invasive surgical options as well as a decrease in stoma rates. Patients with signs of colon ischemia or perforation require emergent surgery, which is associated with an increase in stoma formation, morbidity, mortality, and a decrease in overall survival.

Keywords

colon cancer - rectal cancer - obstructing colorectal cancer - malignant bowel obstruction - large bowel obstruction - endoluminal stent


Publication History

Article published online:
25 February 2022

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