A 68-year-old man presents with acute large bowel obstruction. CT shows a malignant stricture in the proximal sigmoid colon with no signs of perforation or peritonitis. He is medically fit for surgery. According to current guidelines, what is the best management strategy?
- A Emergency total colectomy with ileorectal anastomosis
- B Emergency Hartmann's procedure
- C Endoscopic placement of a self-expanding metallic stent (SEMS) as a bridge to elective surgery ✓
- D Conservative management with nasogastric tube and IV fluids
Correct answer: C. Endoscopic placement of a self-expanding metallic stent (SEMS) as a bridge to elective surgery
Explanation
For malignant left-sided large bowel obstruction in patients without perforation, SEMS placement as a bridge to elective single-stage surgery is the preferred strategy. It converts an emergency operation (with high stoma rates and morbidity) into an elective procedure, allowing mechanical bowel preparation and nutritional optimization. Emergency surgery is reserved for cases with perforation or failed stenting.
Reference: Current Therapy in Colon and Rectal Surgery, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.