Abstract
Despite 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.
Keywords
colon cancer - rectal cancer - obstructing colorectal cancer - malignant bowel obstruction
- large bowel obstruction - endoluminal stent
