Annals of Coloproctology

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Malignant disease,Colorectal cancer

Technical and Clinical Outcomes After Colorectal Stenting in Malignant Large Bowel Obstruction: A Single-Center Experience: Atanu Pal, Janak Saada, Sandeep Kapur, Richard Tighe, Adam Stearns, James Hernon, Chris Speakman; Ann Coloproctol. 2021;37(2):85-89. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.06.12.1

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Abstract PDF: Purpose
Malignant large bowel obstruction is a surgical emergency that requires urgent decompression. Stents are increasingly being used, though reported outcomes are variable. We describe our multidisciplinary experience in using stents to manage malignant large bowel obstruction.
Methods
All patients undergoing colorectal stent insertion for acute large bowel obstruction in a teaching hospital were included. Outcomes, complications, and length of stay (LOS) were recorded.
Results
Over a 7-year period, 73 procedures were performed on 67 patients (37 male, mean age of 76 years). Interventional radiology was involved in all cases. Endoscopic guidance was required in 24 cases (32.9%). In 18 patients (26.9%), treatment intent was to bridge to elective surgery; 16 had successful stent placement; all had subsequent curative resection (laparoscopic resection, 8 of 18; primary anastomosis, 14 of 18). Overall LOS, including both index admission and elective admission, was 16.4 days. Treatment intent was palliative in 49 patients (73.1%). In this group, stents were successfully placed in 41 of 49 (83.7%). Complication rate within 30 days was 20%, including perforation (2 patients), per rectal bleeding (2), stent migration (1), and stent passage (5). Nineteen patients (38.8%) required subsequent stoma formation (6, during same admission; 13, during subsequent admission). Overall LOS was 16.9 days.
Conclusion
In our experience colorectal stents can be used effectively to manage malignant large bowel obstruction, with only selective endoscopic input. As a bridge to surgery, most patients can avoid emergency surgery and have a primary anastomosis. In the palliative setting, the complication rate is acceptable and two-thirds avoid a permanent stoma.

Benign GI diease

Acute Colonic Volvulus in a Mexican Population: A Case Series: Mauricio Gonzalez-Urquijo, Mario Rodarte-Shade, Gerardo Gil-Galindo; Ann Coloproctol. 2020;36(1):48-53. Published online February 18, 2020; DOI: https://doi.org/10.3393/ac.2019.01.02

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6 Citations

Abstract PDF

Purpose
Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial.
Methods
This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes.
Results
A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%.
Conclusion
Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.

Citations

Citations to this article as recorded by

Metachronous descending colon volvulus after sigmoidectomy: a case report
Asratu G Amare, Gebrehiwot A Workneh, Mequanint T Tassew, Minale M Kebede, Mengist A Tegegne, Michael A Negussie
Journal of Surgical Case Reports.2024;[Epub] CrossRef
Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States
Dushyant Singh Dahiya, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Amandeep Singh, Rajat Garg, Chin-I Cheng, Mohammad Al-Haddad, Madhusudhan R. Sanaka, Neil Sharma
Clinical Endoscopy.2023; 56(3): 340. CrossRef
Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients
Sabri Selcuk Atamanalp
Journal of Laparoendoscopic & Advanced Surgical Techniques.2022; 32(7): 763. CrossRef
Recommendations for the Management of Sigmoid Volvulus
Sabri Selcuk Atamanalp
Diseases of the Colon & Rectum.2022; 65(2): e85. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef
Comments on “Acute Colonic Volvulus in a Mexican Population: A Case Series”
Sabri Selcuk Atamanalp
Annals of Coloproctology.2021; 37(3): 131. CrossRef

Self-expandable Metallic Stent for the Management of Acute Malignant Large-bowel Obstruction.: Park, Yoon Ah , Lee, Kwang Hun , Lee, Sun Il , Sohn, Seung Kook; J Korean Soc Coloproctol. 2006;22(1):34-40.

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Abstract PDF: PURPOSE
The purpose of this study was to review our experience with the use of self-expandable metallic stents as the initial interventional management for acute malignant large-bowel obstruction.
METHODS
The records of 35 patients who underwent placement of a colonic stent for acute malignant obstruction at our institution between January 2003 and December 2004 were reviewed.
RESULTS
Stents were placed for palliation in 19 patients and as bridge to surgery in 16 patients. Technical success of stent placement was achieved in all patients (100%), but clinical failure occurred in two patients due to limited expansion of the metallic stent. One of them who had clinical failure underwent an emergency operation, and the other needed no further procedure because of his death. Complications occurred in 4 patients (12%), including one pelvic abscess associated with colon perforation, two minor bleedings, and one anal pain. All the patients in the bridge-to-surgery group underwent an elective colon resection without stoma. In the palliative group, stent reocclusion was observed in three patients during the follow-up (median: 65 days; range: 27~440 days), two of which were managed by reinsertion of a stent. In the remaining patients, the stent was patent until death or the last follow up date (median: 65 days).
CONCLUSIONS
Placement of a self-expandable metallic stent is a safe and effective procedure for immediate decompression of acute malignant large-bowel obstruction. It provides a chance of elective surgery for patients with resectable disease, as well as relief of symptoms for those with unresectable disease.

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