• Humans
• Rectum/injuries
• Rectum/surgery
• Colon/injuries
• Anastomosis, Surgical/methods

• Bridge to surgery
• Colon cancer
• Colorectal surgery
• Emergency treatment
• Intestinal obstruction
• Self-expandable metal stent

In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.

• Major Science and Technology Projects of Zhejiang Province, China
• Natural Science Foundation of Zhejiang Province, China

• SEMS
• close to the anal verge
• malignant colorectal obstruction
• newly developed proximal release-type colonic stent

Synchronous colonic cancer incidence is uncommon, and awareness about this rare condition is improved recently. However, in the presence of acute colonic obstruction, investigation and management of synchronous colonic cancer can be difficult and challenging.

A patient presented with acute colonic obstruction with impending rupture and complete examination of this patient revealed the presence of three colonic cancers, of which two were completely occluding.

The presence of multiple colonic cancers must be ruled out in order to plan the best management. We present the case with a review of literature and discuss the management of the case.

• Colon cancer
• Synchronous cancers
• Colonoscopy
• Obstructive cancer
• Colostomy
• Case report

The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery.

An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann’s procedure, HP), and 35 patients underwent SEMS insertion.

All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission.

SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.

• Colonic obstruction
• Colorectal neoplasms
• Endoscopic stenting
• Hartmann’s procedure

• Complication
• obstruction
• rectal cancer
• stent

• Humans
• Rectal Neoplasms/surgery
• Self Expandable Metallic Stents
• Stents
• Treatment Outcome

There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the 5-year overall survival (OS) and disease-free survival (DFS) of several treatment strategies for acute left malignant colonic obstruction.

We searched for articles published in PubMed, Embase (Ovid), MEDLINE (Ovid), Web of Science, and Cochrane Library between January 1, 2000, and July 1, 2020. We screened out the literature comparing different treatment strategies. Evaluate the primary and secondary outcomes of different treatment strategies. The network meta-analysis summarizes the hazard ratio, odds ratio, mean difference, and its 95% confidence interval.

The network meta-analysis involved 48 articles, including 8 (randomized controlled trials) RCTs and 40 non-RCTs. Primary outcomes: the 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES. Secondary outcomes: compared with emergency resection (ER) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies.

Comprehensive literature research, we find that CS-BTS and DS-BTS strategies can bring better 5-year OS and DFS than ER. DS-BTS strategies have a better 5-year OS than CS-BTS strategies. Without considering the hospital stays, DS-BTS strategy is the best choice.

The online version contains supplementary material available at 10.1186/s13017-021-00355-2.

• Acute left malignant colonic obstruction
• Bridge to surgery
• Colonic stenting
• Decompressing stoma
• Emergency resection
• Network meta-analysis
• Transanal colorectal tube

• Colorectal cancer
• Emergency surgery
• International guidelines
• Left-sided obstruction
• Long-term outcomes
• SEMS
• Short-term outcomes
• “Bridge to Surgery”

• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/pathology
• Intestinal Obstruction/therapy
• Patient Safety
• Risk Assessment
• Risk Factors
• Self Expandable Metallic Stents
• Treatment Outcome

• left-sided malignant bowel obstruction
• meta-analysis
• metallic stent
• systematic review
• transanal drainage tube

• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/complications
• Drainage/instrumentation
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Stents

Colorectal cancer is the most common cancer in Japan. Approximately 10%-20% of the patients with colorectal cancer present with large bowel obstruction, and those who present with malignant colonic obstruction (MCO) require urgent decompression because MCO can cause electrolytic fluid imbalance, colonic necrosis, bacterial translocation, and death. Placement of colonic stents (self-expandable metallic stents) for MCO is a major and standard endoscopic treatment that has been available since 2012 in Japan. This review presents the current conditions and future prospects of this procedure based on the literature. The current indication of colonic stent placement is malignant colorectal stenosis. One of the purposes of using stents is palliative treatment; further, its advantages over emergency surgery with colostomy include avoidance of colostomy, relief of obstruction, shorter hospitalization, and better quality of life. In addition, stent placement can also be used as a bridge to surgery since the duration of the hospitalization is shorter and postoperative complications, colostomy rates, and mortality rates are lower with elective than with emergency surgery. Although recent studies have reported low complication rates related to colonic stents, complications may still occur, highlighting the importance of good preparation, adequate staffing, backup systems, and informed consent. The current major problem related to colonic stents is the lack of evidence on patients' long-term prognoses for bridge to surgery purposes, awaiting the results of ongoing clinical research.

• CROSS
• colonic stent
• malignant colorectal obstruction
• obstructive colorectal cancer

• Colorectal cancer
• Diverting ostomy
• Emergency surgery
• Malignant obstruction
• Stent

• Cancer
• Colon
• Emergency
• Obstruction
• Perforation
• Rectum

• Colectomy/methods
• Colorectal Neoplasms/therapy
• Colostomy/methods
• Guidelines as Topic/standards
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/therapy
• Intestinal Perforation/diagnosis
• Intestinal Perforation/therapy
• Self Expandable Metallic Stents
• Tomography, X-Ray Computed/methods

• Bleeding
• Carcinoma
• Colorectal
• Emergency
• Endoluminal stent
• Obstruction
• Perforation

The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality.

The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality.

Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44).

The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.

• Bridge to surgery
• Colonic obstruction
• Colorectal carcinoma
• Self expanding metallic stents

• Hartmann's procedure
• adjuvant chemotherapy
• obstructive left-sided colorectal cancer
• peritoneal dissemination
• second-look surgery

Colonic complications are rare after acute pancreatitis but are associated with a high mortality. Possible complications include mechanical obstruction, ischaemic necrosis, haemorrhage, and fistula. We report a case of large bowel obstruction in a 31-year-old postpartum female, secondary to severe gallstone pancreatitis. The patient required emergency laparotomy and segmental bowel resection, as well as cholecystectomy. Presentation of obstruction occurs during the acute episode or can be delayed for several weeks. The most common site is the splenic flexure owing to its proximity to the pancreas. Initial management may be conservative, stenting, or surgical. CT is an acceptable baseline investigation in all cases of new onset bowel obstruction. Although bowel obstruction is a rare complication of pancreatitis, clinicians should be aware of it due to its high mortality. Obstruction can occur after a significant delay following the resolution of pancreatitis. Those patients with evidence of colonic involvement on pancreatic imaging warrant further large bowel evaluation. Bowel resection may be required electively or acutely. Colonic stenting has an increasing role in the management of large bowel obstruction but is a modality of treatment that needs further evaluation in this setting.

AIM: To evaluate the safety, efficacy and value of endoscopic intestinal stent placement in the treatment of colorectal cancer complicated with acute intestinal obstruction.

METHODS: A total of 263 patients with colorectal cancer complicated with intestinal obstruction treated at our hospital from January 2010 to December 2014 were included. Stenting treatment was performed under endoscopy and (or) X-ray. The rate of success, the incidence of postoperative complications, the rate of symptom remission, the rate of surgical excision and other indicators were evaluated.

RESULTS: Stent implantation was successful in 258 (98.1%) cases. The rates of adverse events were: perforation, 1.1% (3 cases); hemorrhage, 3.8% (10 cases); fever, 4.6% (12 cases), and others such as stent dislocation and migration, 3.0% (8 cases). The rates of symptom remission were: abdominal pain, 97.3% (256 cases); abdominal distension, 97.3% (258 cases); and anal dysfunction, 98.1% (258 cases). The rates of surgical resection were: 60 cases for palliative treatment, 198 cases for surgical resection 5-13 d after stent implantation after intestinal preparation, and 143 cases for removal of the tumor by one-stage operation.

CONCLUSION: The symptoms of intestinal obstruction can be relieved by endoscopic intestinal stenting. Emergency endoscopic stenting can be used as a bridge treatment before operation, and it can turn emergency operation to elective surgery, turn two-stage operation to one-stage operation, reduce the difficulty and risk of operation for clinicians, reduce the incidence of postoperative complications, relieve pain, and improve survival quality.

• Intestinal obstruction
• Colorectal cancer
• Electronic colonoscopy
• Stents

• Colorectal resection
• Colorectal surgery
• Complications
• Oncology
• Quality improvement

A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future.

• Colon
• Colorectal neoplasms
• Obstruction
• Stents

• Cancer
• Complication
• Endoscopic stenting
• Leak
• Stricture

• large bowel
• emergency
• surgery
• outcome

• Adult
• Aged
• Aged, 80 and over
• Colorectal Neoplasms/epidemiology
• Digestive System Surgical Procedures/statistics & numerical data
• Emergencies
• Female
• Hospital Mortality
• Humans
• Intensive Care Units
• Intestinal Obstruction/epidemiology
• Intestinal Obstruction/surgery
• Intestinal Perforation/epidemiology
• Intestinal Perforation/surgery
• Intestine, Large/surgery
• Ischemia/mortality
• Male
• Middle Aged
• Multiple Organ Failure/mortality
• Patient Admission/statistics & numerical data
• Peritonitis/mortality
• Postoperative Complications
• Retrospective Studies
• United Kingdom/epidemiology
• Young Adult

Since its introduction in the early 1990s, the self-expandable metal stent (SEMS) has been increasingly used for the management of malignant colorectal obstruction, not only as a palliative method but also as a preoperative treatment in surgical candidates. However, more recently, concerns have been raised over stent complication rates. Early complications include pain, perforation, and rectal bleeding, and late complications include stent migration and stent obstruction. With the increasing use of SEMS for treatment, physicians need to be more aware of complications occurring after the placement of these stents. This review covers the technical considerations and management of complications after colonic stenting.

• Colon
• Complications
• Stents

Patients whose colorectal cancer is treated after an emergency admission tend to have late-stage cancer and a poor prognosis. We identified risk factors for an emergency admission by linking data from the National Bowel Cancer Audit (NBCA) and the English Hospital Episode Statistics (HES), an administrative database of all admissions to English National Health Service hospitals, which includes data on mode of admission.

We identified all adults included in the NBCA with a primary diagnosis of bowel cancer, excluding cancer of the appendix, between August 2007 and July 2011 whose record could be linked to HES. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for an emergency admission for colorectal cancer. All risk factors were adjusted for cancer site and calendar year.

97 909 adults were identified with a primary diagnosis of bowel cancer and 82 777 patients could be linked to HES. Patients who were older, female, of a non-white ethnic background, and more socioeconomically deprived, and those with dementia or cardiac, neurologic and liver disease had an increased risk of presenting as an emergency admission. The strongest risk factors were age (90 compared with 70 years: OR 2.99, 95% CI 2.84 to 3.15), dementia (OR 2.46, 2.18 to 2.79), and liver disease (OR 1.87, 1.69 to 2.08).

Our study identifies risk factors that may impair health-seeking behaviour and access to healthcare. An earlier recognition of symptoms in patients with these risk factors may contribute to better outcomes.

• acut műtét
• colorectal cancer
• complications
• emergencies
• kezelés
• surgery
• szövődmény
• treatment
• vastagbéldaganat

Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.

• Colorectal neoplasms
• Obstruction
• Self-expanding metallic stents

• Acute care surgery
• Acute obstruction
• Adhesions
• Cholangitis
• Ischemia
• Volvulus

• Colonic stent
• Malignant large bowel obstruction
• Surgical treatment
• Systematic review

• Aged
• Aged, 80 and over
• Biomarkers
• Carcinoma/complications
• Carcinoma/pathology
• Carcinoma/surgery
• Case-Control Studies
• Cell Differentiation
• Colectomy
• Colonic Neoplasms/complications
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Embolism/epidemiology
• Emergencies
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/pathology
• Intestinal Obstruction/surgery
• Intestinal Perforation/etiology
• Lymphatic Metastasis
• Male
• Metals
• Middle Aged
• Neoplasm Invasiveness
• Postoperative Complications/epidemiology
• Preoperative Care/instrumentation
• Retrospective Studies
• Risk Factors
• Stents
• Tumor Burden
• Ulcer/etiology

• Adult
• Aged
• Aged, 80 and over
• Coated Materials, Biocompatible/adverse effects
• Colonoscopy
• Colorectal Neoplasms/complications
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/therapy
• Male
• Middle Aged
• Palliative Care
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Stents/adverse effects
• Treatment Outcome

• Adult
• Aged
• Aged, 80 and over
• Colonic Diseases/mortality
• Colonic Diseases/surgery
• Colonoscopy/methods
• Colonoscopy/mortality
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/surgery
• Female
• Humans
• Intestinal Obstruction/mortality
• Intestinal Obstruction/surgery
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Middle Aged
• Palliative Care/methods
• Postoperative Complications/etiology
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control
• Proctoscopy/methods
• Proctoscopy/mortality
• Prospective Studies
• Rectal Diseases/mortality
• Rectal Diseases/surgery
• Sigmoid Diseases/mortality
• Sigmoid Diseases/surgery
• Stents
• Time Factors

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann’s procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial.

• Left-sided large bowel obstruction
• Hartmann’s procedure
• Primary anastomosis
• Bowel stent
• Emergency treatment

• Adenocarcinoma/complications
• Adenocarcinoma/surgery
• Aged
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/surgery
• Female
• Humans
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Male
• Palliative Care
• Prosthesis Implantation/instrumentation
• Retrospective Studies
• Stents
• Treatment Outcome