Surgical Dilemmas Associated with Malignant Large Bowel Obstructions

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Colorectal cancer screening aims to reduce incidence, yet a third of patients present with obstruction.
• Malignant large bowel obstruction (MLBO) presents complex challenges in diagnosis and treatment.
• MLBO can lead to severe complications like perforation, ischemia, and electrolyte imbalances.

Purpose of the Study:

• To review the workup and treatment paradigms for malignant large bowel obstruction.
• To discuss the role of self-expandable metallic stents in managing MLBO.
• To highlight the impact of emergent surgery versus stenting on patient outcomes.

Main Methods:

• Review of current literature on malignant large bowel obstruction.
• Analysis of diagnostic workup including cross-sectional imaging.
• Evaluation of treatment strategies: medical optimization, stenting, and surgical resection.

Main Results:

• Emergent intervention is sometimes necessary for patients presenting in extremis.
• Self-expandable metallic stents offer palliation and a bridge to surgery, enabling minimally invasive options.
• Stenting can decrease stoma rates compared to emergent surgery.

Conclusions:

• Effective management of MLBO requires balancing oncologic resection with relief of obstruction and functional outcomes.
• Self-expandable metallic stents are a valuable tool in MLBO management, potentially reducing stoma rates.
• Emergent surgery for MLBO, especially with ischemia or perforation, is associated with increased morbidity and mortality.