CR12 *SELF‐EXPANDABLE METALLIC STENT VS SURGERY IN MANAGEMENT OF ACUTE MALIGNANT LARGE BOWEL OBSTRUCTION

Abstract

Background: Management of acute LBO remains challenging. An urgent surgical intervention is often associated with poorer clinical outcome compared to an elective procedure. SEMS as BTS or palliative measure remain controversial and not widely available.Methods: From 1995 to 2008, retrospective analysis of the patients presenting with an acute malignant LBO to the Tweed and John Flynn Private Hospitals was performed.Results: SEMS were inserted in 31 patients (median age 74 (46–95), 17 females and 14 males, ratio 1.2:1). 12 were elective and therefore excluded. The remaining 19 had emergency SEMS insertion – 12 as BTS and 7 palliative. LOS was 4.5 days (2–21). Tumour was located in the left colon and the rectum (15) and transverse colon (4). 15 patients experienced complete resolution of LBO. 10 patients from the BTS group had subsequently undergone one‐stage curative resection with good outcome. There were 2 deaths and 2 unsuccessful SEMS placements. Urgent operation was performed in 23 patients (median age 74 (52–89), 10 males and 13 females, ratio 1.3:1): 18 Hartmann's procedures, 3 resections with primary anastomosis and 2 defunctioning colostomies. LOS was 17.7 days (2–59). There was 1 death, 1 ongoing pelvic sepsis, 5 significant wound complications, stoma prolapse, AMI, IHD exacerbation, 2 episodes of AF, 3 UTI, pneumonia and 3 cases of prolonged ileus.Conclusions: In expert hands SEMS are effective in treatment of LBO. They are associated with an overall better outcome and improved quality of life of patients. Surgery is indicated, where SEMS are unavailable or have failed.