Long-term Postprocedural Outcomes of Palliative Emergency Stenting vs Stoma in Malignant Large-Bowel Obstruction

Abstract Aim Self-expanding metallic stents (SEMS) as bridge to surgery have been questioned due to the fear of perforation and tumour spread. This study aimed to compare SEMS and stoma as bridge to surgery in acute malignant large bowel obstruction in the Swedish population. Method Medical records of patients identified via the Swedish Colorectal Cancer Register 2007–2009 were collected and scrutinized. The inclusion criterion was decompression intended as bridge to surgery due to acute malignant large bowel obstruction. Patients who underwent decompression for other causes or had bowel perforation were excluded. Primary endpoints were 5-year overall survival and 3-year disease-free survival. Secondary endpoints were 30-day morbidity and mortality rates. Results A total of 196 patients fulfilled the inclusion criterion (SEMS, 71, and stoma, 125 patients). There was no significant difference in sex, age, ASA score, TNM stage and adjuvant chemotherapy between the SEMS and stoma groups. No patient was treated with biological agents. Five-year overall survival was comparable in SEMS, 56 per cent (40 patients), and stoma groups, 48 per cent (60 patients), P = 0.260. Likewise, 3-year disease-free survival did not differ statistically significant, SEMS 73 per cent (43 of 59 patients), stoma 65 per cent (62 of 95 patients), P = 0.32. In the SEMS group, 1.4 per cent (one patient) did not fulfil resection surgery compared to 8.8 per cent (11 patients) in the stoma group (P = 0.040). Postoperative complication and 30-day postoperative mortality rates did not differ, whereas the duration of hospital stay and proportion of permanent stoma were lower in the SEMS group. Conclusion This nationwide registry-based study showed that long-term survival in patients with either SEMS or stoma as bridge to surgery in acute malignant large bowel obstruction were comparable. SEMS were associated with a lower rate of permanent stoma, higher rate of resection surgery and shorter duration of hospital stay.

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Long-term Outcomes of Colonic Stent as a "Bridge to Surgery" for Malignant Large-bowel Obstruction

Case Medical Research ◽

10.31525/ct1-nct04111042 ◽

2019 ◽

Author(s):

Keyword(s):

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Bridge To Surgery ◽

Long Term Outcomes ◽

Colonic Stent

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Long-term outcomes of colorectal cancer patients with and without malignant large-bowel obstruction

Colorectal Cancer ◽

10.2217/crc-2018-0001 ◽

2018 ◽

Vol 7 (2) ◽

pp. CRC04

Author(s):

Shinya Munakata ◽

Yuta Murai ◽

Akihiro Koiuzumi ◽

Hisaki Kato ◽

Riku Yamamoto ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Bowel Obstruction ◽

Large Bowel ◽

Large Bowel Obstruction ◽

Long Term Outcomes ◽

Colorectal Cancer Patients

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Comparison of Long-Term Outcomes of Colonic Stent as “Bridge to Surgery” and Emergency Surgery for Malignant Large-Bowel Obstruction: A Meta-Analysis

Annals of Surgical Oncology ◽

10.1245/s10434-014-3997-7 ◽

2014 ◽

Vol 22 (2) ◽

pp. 497-504 ◽

Cited By ~ 76

Author(s):

Akihisa Matsuda ◽

Masao Miyashita ◽

Satoshi Matsumoto ◽

Takeshi Matsutani ◽

Nobuyuki Sakurazawa ◽

...

Keyword(s):

Bowel Obstruction ◽

Emergency Surgery ◽

Large Bowel ◽

Meta Analysis ◽

Large Bowel Obstruction ◽

Bridge To Surgery ◽

Long Term Outcomes ◽

Colonic Stent

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Pediatric sigmoid volvulus of an extremely long sigmoid colon with hypoganglionosis: a case report

Journal of International Medical Research ◽

10.1177/03000605211032429 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110324

Author(s):

Matjaž Horvat ◽

Marko Hazabent ◽

Marjan Sekej ◽

Milka Kljaić Dujić

Keyword(s):

Sigmoid Colon ◽

Bowel Obstruction ◽

Large Bowel ◽

Treatment Options ◽

Vascular Occlusion ◽

Abdominal Distension ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

History Of

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pediatric patients. This condition occurs when a redundant sigmoid loop with a narrow mesenteric base of attachment to the posterior abdominal wall rotates around its mesenteric axis. This situation might result in vascular occlusion and large bowel obstruction. There are only a few predisposing factors of sigmoid volvulus, such as a long-term history of constipation or pseudo-obstruction with an excessive sigmoid colon. Underlying hypoganglionosis can also lead to large bowel obstruction. There have only been two reported cases of hypoganglionosis with sigmoid volvulus, and both were in adults. Sigmoid volvulus usually presents with abdominal pain, nausea, vomiting, constipation and abdominal distension, an absence of stool, or the presence of melenic stool in the rectum. Initial treatment options are non-surgical for stable patients, although surgical management might be necessary. If sigmoid volvulus is not recognized and resolved, it may lead to serious complications and death. Pediatric sigmoid volvulus is frequently the fulminant type, and therefore, a decision about treatment must be prompt. We present an unusual pediatric case of an extremely long sigmoid colon with hypoganglionosis, which twisted and caused obstruction. This condition was resolved with surgical resection.

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