Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting.
OBJECTIVE
The aim of this study was to clarify the usefulness of the management of acute colorectal obstruction using a transanal drainage tube before surgery or stenting.


METHODS
Fifty-four patients (34 males and 20 females, aged 46-94 yr, mean = 69.7) treated between May 1998 and March 2004 for acute colorectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. Based on abdominal computed tomography findings, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a Dennis Colorectal Tube (DCT) was attempted.


RESULTS
Endoscopic decompression using the DCT was technically successful in 52 of 54 patients (96.3%). The site of obstruction was the cecum in 4, the ascending colon in 2, the transverse colon in 7, the descending colon in 11, the sigmoid colon in 18, and the rectum in 12. The etiology of obstruction was primary colorectal carcinoma in 45, non-colonic metastatic carcinoma in 4, postoperative obstruction in 4, and retrograde intussusception in 1. Following adequate cleansing of the colon, 44 patients underwent a one-stage surgery after 7+/- 3 days (SD; range, 4-10 days). Stenting was successfully used as the final palliative treatment in 4. The use of the DCT alone relieved postoperative stenosis (3 patients) and retrograde intussusception (Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 1982;143:742-7). During these treatments, perforation occurred in one patient with postoperative stenosis of the cecum.


CONCLUSIONS
Management of acute colorectal obstruction using the DCT was found to be effective and safe, irrespective of the site or etiology of the obstruction. Therefore, this procedure should be considered as a primary method for decompression of the obstructed colon before considering surgery or stenting.
Horiuchi
Akira
A
Department of Gastroenterology, Showa Inan General Hospital, Akaho, Komagane, Japan.
Nakayama
Yoshiko
Y
Tanaka
Naoki
N
Kajiyama
Masashi
M
Fujii
Hideyasu
H
Yokoyama
Takahide
T
Hayashi
Ken
K
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D003112:Colonic Pseudo-Obstruction / Q000000981:diagnostic imaging / Q000628:therapy; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000469:parasitology; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed