MALIGNANT COLORECTAL OBSTRUCTION - TREATMENT WITH A FLEXIBLE COVERED STENT

PURPOSE: To evaluate the usefulness of flexible covered stents for tre atment of acute colorectal obstruction secondary to malignant colorect al carcinoma. MATERIALS AND METHODS: Twenty patients with acute colore ctal obstruction secondary to malignant colorectal carcinoma were trea ted by means of intubation of a flexible stent with fluoroscopic guida nce with occasional endoscopic assistance. Two types of stents were pl aced (type 1, completely covered; type 2, two-thirds of proximal part uncovered). Of 15 patients with primary colorectal carcinoma, 12 under went placement of a stent for presurgical decompression of colorectal obstruction; three, for palliative decompression. In three patients wi th rectosigmoid Seeding from advanced gastric carcinoma and two patien ts with recurrent colonic carcinoma, stents were placed for palliative decompression. RESULTS: Stent placement was successful in 18 (90%) of 20 patients. Symptoms of obstruction resolved within 24 hours in 15 ( 75%) patients. Eight patients underwent elective single-stage surgery without complications 5-7 days after stent placement. Two patients und erwent tumor resection and colostomy. In eight patients, stents provid ed palliative decompression of the colon. Type 1 stents migrated in fo ur (50%) of eight patients; type 2 stents were used thereafter. CONCLU SION: Flexible stents effectively relieved acute colonic obstruction S econdary to malignant rectosigmoid neoplasm. Stent placement allowed p atients to undergo single-stage surgery in most cases and provided pal liative decompression in cases of inoperable or disseminated disease.