Download PDF
Clin Colon Rectal Surg 2012; 25(04): 200-203
DOI: 10.1055/s-0032-1329533
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Colonic Obstruction: A Review

Rebecca S. Sawai
1   Department of General Surgery, Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii
› Author Affiliations
Further Information

Publication History

Publication Date:
21 November 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Large bowel obstruction is a common problem with many different causes, the most common being colorectal adenocarcinoma, extracolonic adenocarcinoma, diverticular disease, volvulus, and inflammatory bowel disease. The nature of the obstruction can influence the best management. Historically, treatment of obstruction consisted of surgical removal of the obstruction if possible and decompression of the bowel with an ostomy. Other strategies for managing obstruction have evolved as alternatives to stomas, including primary resection with anastomosis and endoscopic stent placement. The choice of treatment can therefore be tailored to the individual patient with good success.

Keywords

large bowel obstruction - management - colostomy - colectomy - endoscopic stent
 

  • References

  • 1 Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003; 46 (1) 24-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Gordon P. Malignant neoplasms of the colon. In: Gordon PH, Nivatvongs S, , eds. Principles and Practice of Surgery for the Colon, Rectum, And Anus. 3rded. New York: Informa Healthcare USA, Inc; 2007: 489-643
    CrossrefSearch in Google Scholar
  • 3 Melzig EP, Terz JJ. Pseudo-obstruction of the colon. Arch Surg 1978; 113 (10) 1186-1190
    CrossrefPubMedSearch in Google Scholar
  • 4 Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases. Dis Colon Rectum 1986; 29 (3) 203-210
    CrossrefPubMedSearch in Google Scholar
  • 5 Saunders MD. Acute colonic pseudo-obstruction. Gastrointest Endosc Clin N Am 2007; 17 (2) 341-360, vi–vii
    CrossrefPubMedSearch in Google Scholar
  • 6 Williams NS. Large bowel obstruction. In: Keighley MRB, Williams NS, , eds. Surgery of the Anus, Rectum and Colon. 1st ed. London: WB Saunders; 1997: 1823-1866
    Search in Google Scholar
  • 7 Beattie GC, Peters RT, Guy S, Mendelson RM. Computed tomography in the assessment of suspected large bowel obstruction. ANZ J Surg 2007; 77 (3) 160-165
    CrossrefPubMedSearch in Google Scholar
  • 8 Jacob SE, Lee SH, Hill J. The demise of the instant/unprepared contrast enema in large bowel obstruction. Colorectal Dis 2008; 10 (7) 729-731
    CrossrefPubMedSearch in Google Scholar
  • 9 Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009; 69 (3 Pt 2) 654-664
    CrossrefPubMedSearch in Google Scholar
  • 10 Lüning TH, Keemers-Gels ME, Barendregt WB, Tan ACITL, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21 (6) 994-997
    CrossrefPubMedSearch in Google Scholar
  • 11 Mealy K, O'Broin E, Donohue J, Tanner A, Keane FB. Reversible colostomy—what is the outcome?. Dis Colon Rectum 1996; 39 (11) 1227-1231
    CrossrefPubMedSearch in Google Scholar
  • 12 Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005; 189 (4) 384-387
    CrossrefPubMedSearch in Google Scholar
  • 13 Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg 1985; 72 (4) 296-302
    CrossrefPubMedSearch in Google Scholar
  • 14 Kozman DR, Engledow AH, Keck JO, Motson RW, Lynch AC. Treatment of left-sided colonic emergencies: a comparison of US, UK and Australian surgeons. Tech Coloproctol 2009; 13 (2) 127-133
    CrossrefPubMedSearch in Google Scholar
  • 15 Engledow AH, Bond-Smith G, Motson RW, Jenkinson A. Treatment of left-sided colonic emergencies: a comparison of US and UK surgical practices. Colorectal Dis 2009; 11 (6) 642-647
    CrossrefPubMedSearch in Google Scholar
  • 16 Goyal A, Schein M. Current practices in left-sided colonic emergencies: a survey of US gastrointestinal surgeons. Dig Surg 2001; 18 (5) 399-402
    CrossrefPubMedSearch in Google Scholar
  • 17 Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192 (6) 719-725
    CrossrefPubMedSearch in Google Scholar
  • 18 Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 2005; 48 (2) 205-209
    CrossrefPubMedSearch in Google Scholar
  • 19 Corman ML. Carcinoma of the colon. In: Corman ML, , ed. Colon and Rectal Surgery, 5th ed. Philadelphia,PA: Lippincott Williams & Wilkins; 2005: 847
    Search in Google Scholar
  • 20 You YN, Chua HK, Nelson H, Hassan I, Barnes SA, Harrington J. Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum 2008; 51 (7) 1036-1043
    CrossrefPubMedSearch in Google Scholar
  • 21 Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva. 1991; 3: 1507-1512
    PubMedSearch in Google Scholar
  • 22 Tejero E, Mainar A, Fernández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 1994; 37 (11) 1158-1159
    CrossrefPubMedSearch in Google Scholar
  • 23 Sjo OH, Larsen S, Lunde OC, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 2009; 11 (7) 733-739
    CrossrefPubMedSearch in Google Scholar
  • 24 Tierney W, Chuttani R, Croffie J , et al. Enteral stents. Gastrointest Endosc 2006; 63 (7) 920-926
    CrossrefPubMedSearch in Google Scholar
  • 25 Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg 2007; 246 (1) 24-30
    CrossrefPubMedSearch in Google Scholar
  • 26 Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 2009; 144 (12) 1127-1132
    CrossrefPubMedSearch in Google Scholar
  • 27 van Hooft JE, Bemelman WA, Oldenburg B , et al; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12 (4) 344-352
    CrossrefPubMedSearch in Google Scholar
  • 28 Lee JH, Ross WA, Davila R , et al. Self-expandable metal stents (SEMS) can serve as a bridge to surgery or as a definitive therapy in patients with an advanced stage of cancer: clinical experience of a tertiary cancer center. Dig Dis Sci 2010; 55 (12) 3530-3536
    CrossrefPubMedSearch in Google Scholar
  • 29 Harrison ME, Anderson MA, Appalaneni V , et al; ASGE Standards of Practice Committee. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71 (4) 669-679
    CrossrefPubMedSearch in Google Scholar
  • 30 Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 2004; 47 (7) 1201-1207
    CrossrefPubMedSearch in Google Scholar
  • 31 Small AJ, Young-Fadok TM, Baron TH. Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 2008; 22 (2) 454-462
    CrossrefPubMedSearch in Google Scholar