Endoscopic transanal decompression with a drainage tube for acute colonic obstruction: clinical aspects of preoperative treatment.
OBJECTIVE
The study was undertaken to evaluate the clinical usefulness of endoscopic transanal decompression with a newly developed drainage tube for the treatment of acute colonic obstruction.


METHODS
Thirty-six patients ranging in age from 46 to 87 years (average age = 69 years) with acute colorectal obstruction secondary to carcinoma were treated by means of intubation with a flexible drainage tube using combined endoscopic and fluoroscopic guidance. After tube placement, the obstructed colon was aspirated, decompressed, and cleaned with a 50 ml syringe and saline solution. The drainage tube was kept inserted and the colon was irrigated two or three times per day using 500 to 1,000 ml of saline until there were no contents in the colon. The colon was almost empty at the time of operation. The success rate, benefits, and complications of this technique were evaluated.


RESULTS
Placement of the drainage tube was successful in 34 (94.4 percent) of 36 patients. Immediately after aspiration and decompression, symptoms related to obstruction were relieved in 21 patients (61.8 percent), within one hour in 9 patients (26.5 percent) and within four hours in 4 patients (11.8 percent). All 34 patients had elective single-stage surgery without severe complications at the anastomotic site such as anastomotic leakage and postanastomotic stenosis that needed treatment a few days after placement of the drainage tube. In the two cases of unsuccessful placement of the drainage tube, emergent colostomy was performed.


CONCLUSIONS
Decompression with a transanal drainage tube is an easy and safe technique to relieve colonic obstruction effectively without any excess burden to patients. Because the procedure permits single-stage surgery in most cases, it is also cost effective.
Tanaka
T
T
Shiga University of Medical Science and Kohga Public Hospital, Otsu, Japan.
Furukawa
A
A
Murata
K
K
Sakamoto
T
T
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D020685:Colonoscopes; D015179:Colorectal Neoplasms / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D007507:Therapeutic Irrigation