Treatment of left colon neoplasic obstruction by placement of self-expandable stents

Introduction and objective: neoplasic stenoses of the left colon are most f requently caused by primary colon carcinoma, infiltration from an external tumour and great adenomatous polyps. These patients often develop obstructi on as their first symptom, leading to emergency surgical procedures in adve rse circumstances and without an appropriate intestinal preparation that mi ght prevent primary anastomosis. Therapeutic options for this event, such a s Hartmann's resection, subtotal colectomy or anterograde colon lavage are not always possible, in these patients a colostomy is performed that requir es future reoperation for reconstruction of the intestinal transit. Transtu moral self-expandable stenting followed by elective surgery might be the be st option in these cases, as well as an alternative to surgery in non-opera ble patients. Patients and methods: twenty four patients treated with this procedure in t he past four years were divided in two groups. in group 1 (14 patients), th e stent was placed as a permanent and palliative measure for the management of the disease. In group 2 (10 patients), the stent was placed temporarily for the management of the intestinal obstruction and latter the patients u nder went elective surgery with fully preoperative and extension study and an appropriate preparation of the colon in order to allow reliable primary anastomosis. Results: there were no hospital mortality nor stent migrations. There was o nly one complication (perforation caused by the stent) that required emerge ncy surgery, but with any further complications. Failure to place the stent occurred in one patient. Conclusions: self-expandable stents relieve neoplasic colon obstructions an d allow to complete the study protocol, followed by elective surgery associ ated to less morbi-mortality, In patients with advanced or irresectable can cer, they provide a palliative and safe alternative to surgery, with satisf actory results.