A 70-year-old woman with no prior abdominal surgery presents with progressive large bowel obstruction. CT shows a sigmoid colon mass causing complete obstruction with dilation of the right colon. She is haemodynamically stable. What is the most appropriate acute management strategy that also allows future cancer surgery?
- A Emergency Hartmann's procedure
- B Defunctioning loop colostomy
- C Self-expanding metallic stent (SEMS) as bridge to elective surgery ✓
- D Primary resection with on-table colonic lavage and anastomosis
Correct answer: C. Self-expanding metallic stent (SEMS) as bridge to elective surgery
Explanation
In haemodynamically stable patients with malignant left colonic obstruction and no perforation, colonic SEMS as a bridge-to-surgery allows decompression, patient optimisation, staging investigations, and elective laparoscopic resection — avoiding emergency surgery morbidity and temporary stoma. SEMS has a technical success rate of 90-95% for palliative intent or as a bridge. Emergency Hartmann's is reserved for perforation or clinical deterioration. SEMS is now recommended by European and ESCP guidelines as the preferred bridge strategy in suitable patients.
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.