Surgical Dilemmas Associated with Malignant Large Bowel Obstructions

Author:

Schwartzberg David M.1,Valente Michael A.2

Affiliation:

1. Mather Colorectal Surgery, Mather Hospital-Northwell Health, Port Jefferson, New York

2. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

Abstract

AbstractDespite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing cancer. Malignant large bowel obstructions (MLBO) pose a challenging workup and treatment paradigm where an oncologic primary tumor resection must be balanced with relieving the obstruction, functional outcomes, palliation, and consideration for adjuvant therapy. A thorough work up with cross-sectional imaging and medical optimization should be attempted; however, patients may present in extremis and require emergent intervention. The onset of MLBO can be insidious, but result in electrolyte derangements, perforation, small bowel obstruction, hemorrhage, and ischemia. Self-expandable metallic stents have been used as palliation or as a bridge to surgery and have allowed for minimally invasive surgical options as well as a decrease in stoma rates. Patients with signs of colon ischemia or perforation require emergent surgery, which is associated with an increase in stoma formation, morbidity, mortality, and a decrease in overall survival.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology,Surgery

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Large Bowel Obstruction: Etiologies, Diagnosis, and Management;Clinics in Colon and Rectal Surgery;2023-12-29

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