Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction.
OBJECTIVE
To summarize our experience with the application of self-expanding metallic stent (SEMS) in the management of acute left-sided colorectal malignant obstruction.


METHODS
A retrospective chart review of all patients undergoing placement of SEMS between April 2000 and January 2004 was performed.


RESULTS
Insertion of SEMS was attempted in 26 patients under fluoroscopic guidance with occasional endoscopic assistance. The sites of lesions were located in splenic flexure of two patients, left colon of seven patients, sigmoid colon of eight patients and rectum of nine patients. The intended uses of SEMS were for palliation in 7 patients and as a bridge to elective surgery in 19 patients. In the latter group, placement of SEMS allowed for preoperative systemic and bowel preparation and the following one-stage anastomosis. Successful stent placement was achieved in 22 (85%) of the 26 patients. The clinical bowel obstruction resolved 24 hours after successful stent placement in 21 (95%) patients. Three SEMS-related minor complications occurred, two stents migrated and one caused anal pain.


CONCLUSIONS
SEMS represents an effective and safe tool in the management of acute malignant colorectal obstruction. As a bridge to surgery, SEMS can provide time for systematic support and bowel preparation and obviate the need for fecal diversion or on-table lavage. As a palliative measure, SEMS can eliminate the need for emergent colostomy.
Fan
You-Ben
YB
Department of Surgery, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
Cheng
Ying-Sheng
YS
Chen
Ni-Wei
NW
Xu
Hui-Min
HM
Yang
Zhe
Z
Wang
Yue
Y
Huang
Yu-Yao
YY
Zheng
Qi
Q
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents