A 72-year-old man presents with acute left-sided colonic obstruction. CT scan shows an obstructing sigmoid carcinoma with no free perforation. He has no peritonitis and is hemodynamically stable. According to current ESGE/ESCP guidelines, what is the preferred initial management?

• A Emergency Hartmann's procedure
• B Emergency primary resection and anastomosis with on-table lavage
• C Self-expanding metallic stent (SEMS) as bridge to elective surgery ✓
• D Loop transverse colostomy as definitive palliation

Explanation

Current ESGE/ESCP guidelines recommend self-expanding metallic stent (SEMS) as a bridge to elective surgery in fit patients with non-perforated acute left-sided malignant colonic obstruction. This approach decompresses the bowel, allows resuscitation and optimization, avoids emergency surgery mortality (which is threefold higher), and reduces stoma formation rates, enabling planned one-stage laparoscopic resection. Hartmann's procedure carries high stoma formation rates and significant morbidity in emergencies. Emergency primary anastomosis with on-table lavage is an option but carries higher anastomotic leak risk. Loop colostomy is appropriate when stent placement fails or is contraindicated.

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

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Written and medically reviewed by the StethoPrep medical team.