Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases.
BACKGROUND
Acute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. To avoid major postoperative complications, most surgeons advocate two-step surgery despite the increase in patient discomfort and cost. Various methods for performing one-step surgery have been reported including intraoperative colonic lavage, decompression with self-expandable metal stents, and transanal tube decompression.


METHODS
The authors present their experience performing transanal colonic decompression for 51 patients.


RESULTS
Endoscopic tube placement was successful for 43 (84%) of the 51 patients. The emergency clinical situation could be converted to semielective treatment in 37 cases (73%) (30 operations and 6 nonoperative interventions), and to an elective operation in 1 case. After successful colonic decompression, the rate of one-stage operations was 93% (28/30), as compared with 40% (4/10) if the decompression failed.


CONCLUSIONS
Endoscopic tube decompression of acute colonic obstruction is an easy and cost-effective possibility for avoiding emergency operations with all their sequelae. Emergency surgery can be converted to semielective or elective surgery, markedly reducing the rate of staged operations.
Fischer
A
A
Department of General and Visceral Surgery, Albert-Ludwigs-University, Hugstetterstrasse 55, 79106, Freiburg, Germany. andreas.fischer@uniklinik-freiburg.de
Schrag
H J
HJ
Goos
M
M
Obermaier
R
R
Hopt
U T
UT
Baier
P K
PK
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003108:Colonic Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010166:Palliative Care / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome