Skip to main content

Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases

Surgical Endoscopy volume 22, pages 683–688 (2008)Cite this article

Abstract

Background

Acute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. To avoid major postoperative complications, most surgeons advocate two-step surgery despite the increase in patient discomfort and cost. Various methods for performing one-step surgery have been reported including intraoperative colonic lavage, decompression with self-expandable metal stents, and transanal tube decompression.

Methods

The authors present their experience performing transanal colonic decompression for 51 patients.

Results

Endoscopic tube placement was successful for 43 (84%) of the 51 patients. The emergency clinical situation could be converted to semielective treatment in 37 cases (73%) (30 operations and 6 nonoperative interventions), and to an elective operation in 1 case. After successful colonic decompression, the rate of one-stage operations was 93% (28/30), as compared with 40% (4/10) if the decompression failed.

Conclusion

Endoscopic tube decompression of acute colonic obstruction is an easy and cost-effective possibility for avoiding emergency operations with all their sequelae. Emergency surgery can be converted to semielective or elective surgery, markedly reducing the rate of staged operations.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Ohman U (1982) Prognosis in patients with obstructing colorectal carcinoma. Am J Surg Jun 143:742–747

    Article  CAS  Google Scholar 

  2. Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276

    PubMed  Article  CAS  Google Scholar 

  3. Umpleby HC, Williamson RC (1984) Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum 27:299–304

    PubMed  Article  CAS  Google Scholar 

  4. Deutsch AA, Zelikovski A, Sternberg A, Reiss R (1983) One-stage subtotal colectomy with anastomosis for obstructing carcinoma of the left colon. Dis Colon Rectum 26:227–230

    PubMed  Article  CAS  Google Scholar 

  5. Barillari P, Aurello P, De AR, Valabrega S, Ramacciato G, D’Angelo F, Fegiz G (1992) Management and survival of patients affected with obstructive colorectal cancer. Int Surg 77:251–255

    PubMed  CAS  Google Scholar 

  6. Griffith RS (1992) Preoperative evaluation: Medical obstacles to surgery. Cancer 70(5 Suppl):1333–1341

    PubMed  Article  CAS  Google Scholar 

  7. Binkert CA, Ledermann H, Jost R, Saurenmann P, Decurtins M, Zollikofer CL (1998) Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents--a preliminary report. Radiology 206:199–204

    PubMed  CAS  Google Scholar 

  8. Murray JJ, Schoetz DJ Jr, Coller JA, Roberts PL, Veidenheimer MC (1991) Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Dis Colon Rectum 34:527–531

    PubMed  Article  CAS  Google Scholar 

  9. Vigder L, Tzur N, Huber M, Mahagna M, Amir I (1985) Management of obstructive carcinoma of the left colon. Comparative study of staged and primary resection. Arch Surg 120:825–828

    PubMed  CAS  Google Scholar 

  10. Terasaka R, Itoh H, Nakafusa Y, Matsuo K (1990) Effectiveness of a long intestinal tube in a one-stage operation for obstructing carcinoma of the left colon. Dis Colon Rectum 33:245–248

    PubMed  Article  CAS  Google Scholar 

  11. Adachi Y, Okita K, Nozoe T, Iso Y, Yoh R, Matsumata T (1999) Long tube for obstructing left-sided colon cancer. Dig Surg 16:178–179

    PubMed  Article  CAS  Google Scholar 

  12. Baron TH, Kozarek RA (2004) Endoscopic stenting of colonic tumours. Best Pract Res Clin Gastroenterol 18:209–229

    PubMed  Article  Google Scholar 

  13. Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I (2000) Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation. Radiology 216:492–497

    PubMed  CAS  Google Scholar 

  14. Martinez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406

    PubMed  Article  Google Scholar 

  15. Khot UP, Lang AW, Murali K, Parker MC (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102

    PubMed  Article  CAS  Google Scholar 

  16. Baron TH, Harewood GC (2003) Enteral self-expandable stents. Gastrointest Endosc 58:421–433

    PubMed  Article  Google Scholar 

  17. Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S (2004) Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum 47:1201–1207

    PubMed  Article  Google Scholar 

  18. Baron TH, Dean PA, Yates MR III, Canon C, Koehler RE (1998) Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc 47:277–286

    PubMed  Article  CAS  Google Scholar 

  19. Mainar A, De Gregorio Ariza MA, Tejero E, Tobio R, Alfonso E, Pinto I, et al. (1999) Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery: results of a multicenter study. Radiology 210:65–69

    PubMed  CAS  Google Scholar 

  20. Knopfle E, Mayer H, Wamser G, Bohndorf K, Witte J (2001) Ileus in colorectal carcinoma: preoperative implantation of self-expanding metal stents and early elective surgery as an alternative to emergency surgery. Chirurg 72:1137–1143

    PubMed  Article  CAS  Google Scholar 

  21. Mucci-Hennekinne S, Kervegant AG, Regenet N, Beaulieu A, Barbieux JP, Dehni N, Casa C, Arnaud JP (2007) Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surg Endosc

  22. Jost RS, Jost R, Schoch E, Brunner B, Decurtins M, Zollikofer CL (2007) Colorectal stenting: an effective therapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 30:433–440

    PubMed  Article  Google Scholar 

  23. Ng KC, Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study. J Gastrointest Surg 10:798–803

    PubMed  Article  Google Scholar 

  24. Eguchi T, Takahashi Y, Asai S, Ishii Y, Fujii M (1999) Study of long intestinal tube for decompression of obstructive left colon cancer. Hepatogastroenterology 46:2835–2838

    PubMed  CAS  Google Scholar 

  25. Yokohata K, Sumiyoshi K, Hirakawa K (2006) Merits and faults of transanal ileus tube for obstructing colorectal cancer. Asian J Surg 29:125–127

    PubMed  Article  Google Scholar 

  26. Horiuchi A, Nakayama Y, Tanaka N, Kajiyama M, Fujii H, Yokoyama T, Hayashi K (2005) Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. Am J Gastroenterol 100:2765–2770

    PubMed  Article  Google Scholar 

  27. Tanaka T, Furukawa A, Murata K, Sakamoto T (2001) Endoscopic transanal decompression with a drainage tube for acute colonic obstruction: clinical aspects of preoperative treatment. Dis Colon Rectum 44:418–422

    PubMed  Article  CAS  Google Scholar 

  28. Nozoe T, Matsumata T (2000) Usefulness of preoperative colonic lavage using transanal ileus tube for obstructing carcinoma of left colon: device to perform one-stage operation safely. J Clin Gastroenterol 31:156–158

    PubMed  Article  CAS  Google Scholar 

  29. Horiuchi A, Maeyama H, Ochi Y, Morikawa A, Miyazawa K (2001) Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction. Gastrointest Endosc 54:229–232

    PubMed  CAS  Google Scholar 

  30. Araki Y, Isomoto H, Matsumoto A, Kaibara A, Yasunaga M, Hayashi K, Yatsugi H, Yamauchi K (2000) Endoscopic decompression procedure in acute obstructing colorectal cancer. Endoscopy 32:641–643

    PubMed  Article  CAS  Google Scholar 

  31. Lelcuk S, Merhav A, Klausner JM, Gutman M, Greif F, Rozin R (1987) Rectoscopic decompression of acute recto-sigmoid obstruction. Endoscopy 19:209–210

    PubMed  CAS  Article  Google Scholar 

  32. Lelcuk S, Ratan J, Klausner JM, Skornick Y, Merhav A, Rozin RR (1986) Endoscopic decompression of acute colonic obstruction: avoiding staged surgery. Ann Surg 203:292–294

    PubMed  Article  CAS  Google Scholar 

  33. McGregor JR, O’Dwyer PJ (1993) The surgical management of obstruction and perforation of the left colon. Surg Gynecol Obstet 177:203–208

    PubMed  CAS  Google Scholar 

  34. Sjodahl R, Franzen T, Nystrom PO (1992) Primary versus staged resection for acute obstructing colorectal carcinoma. Br J Surg 79:685–688

    PubMed  Article  CAS  Google Scholar 

  35. Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W (2007) Urgent surgery in colon carcinoma. Zentralbl Chir 132:16–25

    PubMed  Article  CAS  Google Scholar 

  36. Riedl S, Wiebelt H, Bergmann U, Hermanek P Jr (1995) Postoperative complications and fatalities in surgical therapy of colon carcinoma: Results of the German multicenter study by the Colorectal Carcinoma Study Group. Chirurg 66:597–606

    PubMed  CAS  Google Scholar 

  37. Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188

    PubMed  Article  CAS  Google Scholar 

  38. Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG (2007) Comparison of colonic stenting and open surgery for malignant large bowel obstruction. Surg Endosc 21:225–233

    PubMed  Article  CAS  Google Scholar 

  39. Tobaruela E, Camunas J, Enriquez-Navascues JM, Diez M, Ratia T, Martin A, Hernandez P, Lasa I, Martin A, Cambronero JA, Granell J (1997) Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 89:13–22

    PubMed  CAS  Google Scholar 

  40. Baccari P, Bisagni P, Crippa S, Sampietro R, Staudacher C (2006) Operative and long-term results after one-stage surgery for obstructing colonic cancer. Hepatogastroenterology 53:698–701

    PubMed  Google Scholar 

  41. Biondo S, Perea MT, Rague JM, Pares D, Jaurrieta E (2001) One-stage procedure in non-elective surgery for diverticular disease complications. Colorectal Dis 3:42–45

    PubMed  Article  CAS  Google Scholar 

  42. Tan SG, Nambiar R, Rauff A, Ngoi SS, Goh HS (1991) Primary resection and anastomosis in obstructed descending colon due to cancer. Arch Surg 126:748–751

    PubMed  CAS  Google Scholar 

  43. Saida Y, Sumiyama Y, Nagao J, Takase M (1996) Stent endoprosthesis for obstructing colorectal cancers. Dis Colon Rectum 39:552–555

    PubMed  Article  CAS  Google Scholar 

  44. Hasegawa S, Ohta M, Mori R, Misuta K, Kobayashi S, Nakano A (2003) Perforation caused by a transanal decompression tube in large bowel obstruction. J Clin Gastroenterol 37:195–196

    PubMed  Article  Google Scholar 

  45. Hsu TC (2005) Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 189:384–387

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of General and Visceral Surgery, Albert-Ludwigs-University, Hugstetterstrasse 55, 79106, Freiburg, Germany

    A. Fischer, H. J. Schrag, M. Goos, R. Obermaier, U. T. Hopt & P. K. Baier

Authors
  1. A. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. J. Schrag
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Goos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Obermaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. T. Hopt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. K. Baier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Fischer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fischer, A., Schrag, H.J., Goos, M. et al. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surg Endosc 22, 683–688 (2008). https://doi.org/10.1007/s00464-007-9461-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9461-z

Keywords

  • Acute colonic obstruction
  • Endoscopic decompression