A 70-year-old man presents with acute large bowel obstruction. CT abdomen shows a sigmoid colon carcinoma causing 95% luminal narrowing, no peritonitis, no perforation. The preferred treatment approach in a non-specialized center is:

• A Emergency Hartmann's procedure
• B Self-expanding metallic stent (SEMS) as bridge to surgery ✓
• C Primary resection and anastomosis with on-table colonic lavage
• D Defunctioning loop colostomy followed by elective resection

Explanation

Self-expanding metallic stent (SEMS) as a bridge to elective surgery (BTS) is the recommended strategy for left-sided colonic obstruction without perforation or peritonitis in centers with adequate endoscopic expertise, as it decompresses the colon, allows staging, patient optimization, and enables a one-stage elective resection with primary anastomosis rather than a Hartmann's procedure. CREST trial and ESCO trial data favor SEMS-BTS in suitable candidates. Emergency Hartmann's procedure carries higher morbidity; primary anastomosis without stenting carries anastomotic leak risk in unprepared bowel.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.