4513 Usefulness of dennis™ colorectal tube in endoscopic decompression of acute colonic obstruction.

Abstract

Background/Aim: Traditionally obstructive carcinoma of colon has been treated by a staged procedure namely proximal colostomy or resection of the tumor with a colostomy. Definitive treatment is reserved as a later procedure. This usually entails two or three laparotomies. To avoid multiple operations for acute colonic obstructions, endoscopic decompression of the obstructive sigmoid or left colon has been attempted, but endoscopic decompression of the obstructive right colon was impossible. Using Dennis TM Colorectal tube, we experienced successful decompression of the obstructive right colon endoscopically and evaluated its usefulness in endoscopic decompression of acute colonic obstruction. Methods: From Jan.1998 to Nov. 1999, 11 patients (7 males and 4 females, age 65 to 89, mean=78) who underwent endoscopic decompression were identified in colon carcinoma database, and they were reviewed. All patients were admitted for abdominal pain, vomiting and constipation. Plain abdominal x ray film showed a distended large bowel. Abdominal CT suggested the site of carcinoma of the colon and the proximal dilation of colon. In eight of these patients, an obstructive carcinoma of the sigmoid colon was found. Each patient had an obstructive carcinoma of descending colon, transverse colon and cecum. Following an enema, a colonoscope (CF230I, Olympus, Tokyo, Japan) was advanced to the site of the tumor.A well-lubricated flexible guide wire is then introduced through the tumor beyond the point of obstruction. Ileus tube TM (Create Medic, Yokohama, Japan) or Dennis TM Colorectal tube (Sherwood, Tokyo, Japan) was tried to insert with the aid of colonoscope. Results: In all 8 patients with sigmoid colon carcinoma endoscopic decompression was successful using Ileus tube TM . Although we have not been able to insert and decompress descending colon, transverse colon or cecum using Ileus tube TM in three patients, insertion of Dennis TM Colorectal tube was possible. Conclusion: DennisTM Colorectal tube is an excellent material for endoscopic decompression of acute colonic obstruction. If it is utilized with the aid of the colonoscope, endoscopic decompression of obstructive right colon may be successful. Therefore, this may allow immediate decompression and further preparation of the entire colon for a one-stage surgery.