A 70-year-old man presents with acute left-sided colonic obstruction due to sigmoid carcinoma. CT shows no peritoneal disease or distant metastases. He is haemodynamically stable. Current evidence-based practice (endorsed by ESGE/ESMO guidelines) recommends which of the following as the preferred management?
- A Emergency Hartmann's procedure
- B Emergency primary resection and anastomosis
- C Self-expanding metallic stent (SEMS) as bridge to elective surgery ✓
- D On-table colonic lavage and primary anastomosis
Explanation
For left-sided malignant colonic obstruction in patients suitable for elective resection, ESGE 2020 and ESMO guidelines recommend colonic SEMS as a bridge to elective curative surgery as the preferred strategy in centres with appropriate expertise, because it converts an emergency to a planned procedure with significantly lower stoma rates and 30-day morbidity. However, SEMS is associated with a small risk of perforation (~4%) and debated concerns about oncological outcomes; therefore, it is contraindicated if perforation is suspected. Emergency Hartmann's remains appropriate for perforated or peritonitic patients. On-table lavage is less commonly performed now.
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.