A 72-year-old man presents with complete large bowel obstruction from an unresectable-appearing sigmoid adenocarcinoma. There is no perforation and no peritonitis. He is a poor surgical candidate. Which intervention best serves as a bridge to definitive decision-making or palliation?
- A Self-expanding metallic stent placed endoscopically across the tumor ✓
- B Emergency three-stage surgical bypass starting with a transverse colostomy
- C Percutaneous cecostomy tube insertion
- D High-volume warm saline enemas with glycerin suppositories
Correct answer: A. Self-expanding metallic stent placed endoscopically across the tumor
Explanation
Self-expanding metallic stenting provides rapid relief of malignant large bowel obstruction without general anesthesia, avoiding an emergency laparotomy and a stoma in a high-risk patient. It can act as a bridge allowing optimization before elective resection, or provide durable palliation in unresectable disease. B transverse colostomy remains a valid surgical fallback when stenting fails or is unavailable, but it commits the patient to major surgery with higher morbidity. Enemas are ineffective against mechanical obstruction.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.