Objective:
Acute mechanical large bowel obstructions comprise 15% of colorectal emergencies as well as 30% of hospital admittance due to colon carcinoma. Surgical therapy options are still debatable. Morbidity and mortality rates are high in elderly cases with comorbid diseases. The aim of this study is to evaluate the surgical therapy options in cases presenting with mechanical large bowel obstructions due to colon carcinoma.
Material and Methods:
Thirty-two cases with acute mechanical large bowel obstruction presenting with abdominal pain, nausea and vomiting among 184 cases operated for colon carcinoma between March 2003 and November 2005 were included in this retrospective study. Age, gender, presenting symptoms on admittance, presence of comorbid diseases, diagnosis, adjuvant treatment options, type of surgical and endoscopic therapy, and results were evaluated.
Results:
Female to male ratio was 12/20 with a mean age of 58 (48-85). Twenty-one cases had (65.6%) comorbid diseases. Emergency colonoscopy was performed in 19 cases (59.3%) to confirm the diagnosis. Type of surgical procedure performed was sigmoid resection in 14 cases (43.7%), right hemicolectomy in 7 cases (21.8%), and subtotal colectomy in 5 cases (15.6%). In 11 of these cases (34.3%) primary anastomosis was performed whereas either colostomy or ileostomy was performed in the remaining 15 cases (46.8%). Stent placement was applied to 6 cases (18.7%). The morbidity rate was 37.5% (12 cases) with 6 of them being major complications occurring in the abdomen. Mean hospital stay was 11.9 (3-25) days. The mortality rate was 15.6% (5 cases).
Conclusion:
There are several treatment options in the therapy of acute mechanical large bowel obstructions. Emergency colonoscopy is beneficial in diagnosis and selection of the appropriate treatment. Primary anastomosis, colostomy or stent placements are the favorite options according to the condition of the cases.
Keywords: Colon carcinoma, obstruction, resection, stent