Acute malignant colorectal obstruction. Preoperative application of self-expanding metallic stents as an alternative to emergency surgery

Introduction: The objective of this study was to evaluate preoperative deco mpression with self-expanding metallic stents in patients with acute bowel obstruction due to colorectal carcinoma. Methods: In 28 patients, admitted to our clinic between January 1996 and May 1999 with suspicion of acute col onic obstruction caused by a colorectal carcinoma, we attempted to insert u nder fluoroscopic control a self-expanding metallic stent in the stenosis. After successful relief of obstruction, an elective one-stage surgical proc edure followed. Results: The stent application was technically successful i n 21 patients. In 19 patients symptom relief was reached within 2 days. One of these patients died perioperatively and two patients developed an anast omotic leakage. In eight of the other nine patients, in whom decompression was not possible, an emergency surgical procedure was performed; four of th ese patients died perioperatively. In only one of the five patients who sur vived, could a surgical procedure without an enterostoma be performed. Conc lusion: In cases of acute malignant colorectal obstruction, preoperative st ent application under fluoroscopic control is a reliable method to allow si ngle-stage surgical resection without requiring a protective enterostoma.