A 74-year-old man presents with complete large bowel obstruction. CT confirms an annular carcinoma of the sigmoid colon causing obstruction, with no free air, no perforation, and no signs of ischaemia. He is planned for a single-stage definitive surgical resection after relief of obstruction. What is the most appropriate immediate intervention?
- A Emergency Hartmann's procedure
- B Transverse loop colostomy followed by staged resections
- C Self-expanding metallic stent as a bridge to elective surgery ✓
- D Colonoscopic balloon dilatation of the tumour
Correct answer: C. Self-expanding metallic stent as a bridge to elective surgery
Explanation
In left-sided malignant large bowel obstruction without perforation or ischaemia, endoscopic placement of a self-expanding metal stent decompresses the bowel and allows resuscitation, full staging, mechanical preparation, and an elective single-stage resection with primary anastomosis, as supported by the European trials of stenting as a bridge to surgery. Emergency Hartmann's remains standard when perforation or ischaemia is present. Balloon dilatation carries a high perforation risk and treats nothing definitively.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.