An 80-year-old frail woman presents with complete large bowel obstruction due to an unresectable sigmoid carcinoma with widespread liver metastases. She has no peritonitis. Colonoscopy confirms a short stricturing tumour. Which intervention best relieves her obstruction?
- A Self-expanding metallic colonic stent across the tumour ✓
- B Emergency subtotal colectomy with ileorectal anastomosis
- C Transverse loop colostomy only if the stent fails, as first choice
- D Percutaneous caecostomy
Correct answer: A. Self-expanding metallic colonic stent across the tumour
Explanation
For malignant large bowel obstruction in a patient unfit for or not benefiting from major resection, a self-expanding metal stent provides rapid palliative decompression, avoiding a laparotomy and stoma in poor-risk patients. In fit patients with resectable disease, a stent can serve as a bridge to elective surgery. Loop colostomy remains the fallback when stenting is technically impossible. Caecostomy does not adequately decompress a left-sided 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.