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Surgical Endoscopy

, Volume 32, Issue 4, pp 2151–2155 | Cite as

“To stent or not to stent?”: immediate emergency surgery with laparoscopic radical colectomy with CME and primary anastomosis is feasible for obstructing left colon carcinoma

  • Salomone Di SaverioEmail author
  • Arianna Birindelli
  • Edoardo Segalini
  • Matteo Novello
  • Anna Larocca
  • Francesco Ferrara
  • Gian Andrea Binda
  • Marco Bassi
Video

Abstract

Great debate exists in the initial acute management of large bowel obstruction from obstructing left colon carcinoma. While endoscopic stenting is well established as the first approach in the setting of palliative care of patients with advanced metastatic disease as well as a bridge to elective surgery in elderly patients who have an increased risk of postoperative mortality (age >70 years and/or ASA status ≥3), controversies exist regarding oncological safety and long-term outcomes of endoscopic colonic stenting in younger patients and ESGE Guidelines do not recommend SEMS placement in patients <70 and fit for curative surgery. Particularly, the Consensus Panelists currently state that SEMS placement as a bridge to surgery is not recommended as the standard treatment because (1) it does not reduce the postoperative mortality in the general population, (2) SEMS may be associated with an increased risk of tumor recurrence, and (3) acute resection is feasible in young and fit patients, with an acceptable postoperative mortality rate. A 32-year-old lady was admitted with complete LBO from obstructing sigmoid carcinoma. Initial i.v. CE-CT scan detected a large bowel partial obstruction with fecal impaction in the entire colon until sigmoid with some mildly dilated SB loops. The presence of a thickened area in the colonic wall could not be assessed because the patient was young and thin and in such patients the CT appearance of bowel wall cannot be clearly appreciated. She was initially managed with laxatives and gastrografin. The patient’s obstruction did not improve and abdominal distension worsened with nausea and colicky pain. Urgent endoscopy detected a friable mass, consistent with completely obstructing carcinoma of the mid sigmoid. Biopsies were taken and distal ink marking was made. Whole-body urgent CT scan with i.v. contrast was performed in order to obtain full preoperative staging and to rule out distant metastases. CT scan and the previously given oral gastrografin confirmed complete large bowel obstruction with a tight stricture in the sigmoid. Cecum was markedly distended.

Keywords

Colorectal cancer Stenting SEMS Large bowel obstruction Bridge to surgery Emergency surgery Malignant bowel obstruction Laparoscopy Minimally invasive surgery GI surgery GI radiology CT scan Endoscopy 

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Notes

Compliance with ethical standards

Disclosures

Dr. Salomone Di Saverio, Dr. Arianna Birindelli, Dr. Edoardo Segalini, Dr. Anna Larocca, Dr. Francesco Ferrara, Dr. Matteo Novello, Dr Gian Andrea Binda, and Dr. Marco Bassi declare that they have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2017_5763_MOESM1_ESM.jpg (65 kb)
Supplementary material 1. Intraoperative appearance of the stenosing sigmoid Ca (JPEG 64 kb)
464_2017_5763_MOESM2_ESM.jpg (65 kb)
Supplementary material 2. IMV is isolated at its origin close to the Treitz ligament (JPEG 64 kb)
464_2017_5763_MOESM3_ESM.png (1.1 mb)
Supplementary material 3. Section of IMV at the level of its origin (PNG 1154 kb)
464_2017_5763_MOESM4_ESM.png (1 mb)
Supplementary material 4. Surgical Specimen showing the complete mesocolic excision and proper central vascular ligation (PNG 1063 kb)

Supplementary material 5. This video is also available in http://youtu.be/eHu4e5kWUYw (MP4 337072 kb)

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Emergency and Trauma Surgery UnitMaggiore Hospital Regional Emergency Surgery and Trauma CenterBolognaItaly
  2. 2.Gastroenterology and Endoscopy UnitMaggiore Hospital Regional Emergency Surgery and Trauma CenterBolognaItaly
  3. 3.Department of SurgeryGalliera HospitalGenoaItaly

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