Neoplastic obstruction of the small and large intestine

Obstructive symptoms due to small bowel tumors are the most common indication of primary malignant disease in the small intestine. Primary obstructing tumors of the small bowel are treated best by resection and primary anastomosis. Malignant lesions of the duodenum sometimes will require pancreaticoduodenectomy and those of the distal ileum, right hemicolectomy. Obstruction due to localized metastatic disease can be treated by resection and primary anastomosis but, more frequently, one or more side-to-side enteroenterostomies will be needed, especially in abdominal carcinomatosis. The complication of LBO due to colorectal cancer is an ominous sign. The less favorable prognosis is a result of the higher operative mortality, advanced stage of disease and lower resectability rate. Obstructing neoplasms of the right side of the colon are treated best by immediate resection and primary anastomosis. Left-sided colon obstruction due to malignancy traditionally is treated by preliminary diversion followed later by definitive resection. Insufficient data are available to evaluate any benefit on operative mortality and long-term survival with a more aggressive approach involving decompression and resection of the obstructing carcinoma at the initial operation. It is doubtful that any marked improvement in current mortality and survival figures will result from wide deviations of the current principles of operative managment. Early diagnosis of the cancer before obstruction occurs remains the primary means of improving survival rates. This involves not only primary means of improving survival rates. This involves not only patient education regarding presenting symptoms, but improvement of physician recognition and response to these complaints so that the appropriate tests are ordered and treatment is initiated.