Self-expandable metal stent in the treatment of obstructive cancer of the descending colon. Preliminary results and review of the literature.

Aim: to report our preliminary experience with self-expandable metal stent in the treatment of acute malignant obstruction of the left colon and to re view the literature on this specific subject. Patients and methods: from Ma rch to September 1999, 8 consecutive patients with a mean age 71 were admit ted as an emergency for acte malignant obstruction of the left colon. A sel f-expandable metal stent was inserted under radioscopic and, in 4 cases, en doscopic guidance. The patients then underwent bowel preparation before ope ration, if required. Results: there was no mortality. Bowel preparation was satisfactory in 6 cases. Complications occurred in 1 patient, who was oper ated on day one for peritonitis due to perforation of the tumour by the pro sthesis inserted after dilatation. Another six patients were operated: 2 ha d resection followed by anastomosis; 3 had resection and anastomosis protec ted by ileostomy; 2 had Hartmann's procedure. The last patient retained the prosthesis as palliation. In the literature, self-expandable metal stent a pplication in obstructed carcinoma of the left colon gives satisfactory res ults. Conclusion: based on our experience and a review of the literature, w e provide practical recommendations when inserting self-expandable metal st ents for acute malignant left colonic obstruction.