[Endoscopic-laparoscopic treatment of neoplastic occlusion of the left colon].
About a third of patients with colorectal carcinoma have acute colonic obstruction requiring emergency surgery. The surgical options are: intraoperative lavage and resection of the colonic segment involved with primary anastomosis; subtotal colectomy with primary anastomosis; colostomy followed by resection; and resection of the colonic segment involved with an end colostomy (Hartman's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and are associated with a poor quality of life. Endoscopic colonic stent insertion effectively decompresses the obstructed colon allowing bowel preparation and elective resection. In this article we present 2 cases successfully treated with the use of stents followed by a laparoscopic resection. We also describe technical details concerning the endoscopy and laparoscopy procedure, discuss the advantages of this treatment and present a review of the literature. One patient underwent a left hemicolectomy; while the other was treated with splenic flexure resection. No complications occurred after surgery. Histological staging revealed a pT3 pNO pMx G2 and a pT4 pN1 pM1 G2 adenocarcinoma, respectively. This initial experience shows that endoscopic colonic stent insertion can effectively resolve the neoplastic obstruction, allowing safe elective surgery. The use of stents does not prevent a laparoscopic approach.
Stipa
Francesco
F
Dipartimento di Chirurgia Generale, Azienda Ospedaliera San Giovanni-Addolorata, Roma.
Bascone
Bruno
B
Cimitan
Andrea
A
Villotti
Giuseppe
G
Burza
Antonio
A
Site
Pietro Delle
PD
Vitale
Alessandro
A
Iacopini
Giampaolo
G
D000230:Adenocarcinoma / Q000150:complications* / Q000601:surgery*; D000368:Aged; D003108:Colonic Diseases / Q000209:etiology* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male