Surgical alternatives in acute intestinal obstructions due to colorectal malignancies

Abstract

Purpose: Obstructing colorectal cancer is associated with a high operative mortality and a worse prognosis. The surgical management of these patients still remains controversial. In this study, we aimed to evaluate retrospectively our approach to the patients presented to our clinic for acute mechanic intestinal obstruction caused by colorectal malignancy, and to discuss treatment results.

Material and Methods: Age, sex, physical examination findings, diagnostic methods, interval between application and operation time, operative findings and tumor localization, surgical and anastomosis technique, localization of stomas, complications, intensive care and hospital stay and mortality rates of 27 patients were recorded by searching the patients' files.

Results: Our patients consisted of 18 males and 9 females with a median age of 53 (19-90). Abdominal distention and tenderness with palpation were the most frequent physical examination findings. All patients had plain abdominal graphy while abdominopelvic ultrasonography and/or colonoscopy were used only for suitable patients. Interval between application and operation time was 36 hours (24-72 h). The most frequent tumor localization was in sigmoid colon (9 patients, %33.3) Resection with primary anastomosis was the preferred approach in 19 patients (70%). Nine (47%) of anastomosis were made by hand and 8 of them made by stapler while in 2 patients combination of two techniques were used. In 7 patients who were not suitable for resection, a diverting stoma was constructed and in one patient an ileo-colonic by-pass was the of choice. Morbidity was seen in 7 patients (3 patients with resection with primary anastomosis, 4 patients with stoma) and 7 patients (26%) died in the postoperative period. Median intensive care stay was 4 days[3 (1-4 days) days in resection with primary anastomosis patients; 5 days (3-32 days) in stoma patients] while median hospital stay was 8 days (4-32)[7 (4-28 days) days in resection with primary anastomosis patients; 11 days (6-32 days) in stoma patients].

Conclusion: Emergency resection with primary anastomosis in colorectal tumors can be performed with a low morbidity and mortality rates in selected patients.