A 74-year-old man presents with large bowel obstruction. CT shows an annular constricting tumour of the sigmoid colon with proximal dilation but no perforation or ischaemia. Staging shows no distant metastases and he is a suitable candidate for curative resection after optimisation. What is the most appropriate immediate management?

• A Emergency subtotal colectomy with ileostomy
• B Emergency Hartmann's procedure
• C Defunctioning transverse loop colostomy followed by chemotherapy first
• D Self-expanding metallic colonic stent as a bridge to elective surgery ✓

Explanation

In a fit patient with an obstructing left-sided colon cancer and no perforation, endoluminal self-expanding metal stenting relieves obstruction, allows bowel preparation, nutritional optimisation, and staging, and converts an emergency operation into an elective single-stage resection with primary anastomosis. Emergency Hartmann's or subtotal colectomy is reserved for perforation, ischaemia, failed stenting, or patients unfit for further surgery.

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.