대한대장항문학회

Purpose : Acute lower gastrointestinal obstruction due to colorectal neoplasm is a common<br>clinical problem, which frequently requires emergency operation. Morbidity and mortality<br>associated with emergency operation is relatively high, and almost all requires a multi-stage<br>operation. Recently flexible rectal stent has been emerged as an alternative for the<br>management of acute lower gastrointestinal obstruction due to colorectal neoplasm. Thus we<br>analyzed the results of flexible rectal stent treatment for acute lower gastrointestinal<br>obstruction due to colorectal neoplasm. Methods : From June 1996 to May 1999 47 patients<br>with acute malignant lower gastrointestinal obstruction were included in this study, medical<br>records of these patients were reviewed retrospectively. Results : Of 47 patients 19 were male<br>and 28 were women, with a mean age of 57.3 years (33∼77 years). Male to female ratio was<br>1：1.47. Causes of acute intestinal obstruction were as follows: rectal cancer, 17 patients;<br>sigmoid colon cancer, 18 patients; descending colon cancer, 3 patients; ascending colon cancer,<br>1 patient; stomach cancer, 5 patients; gall bladder cancer, 1 patient; and uterine cervix cancer,<br>1 patient; and ovarian cancer, 1 patient. Stent insertion was indicated as palliative treatment<br>in 22 patients and preoperative decompression in 25 patients. Successful stent insertions were<br>achieved in 40 patients (85.1%). Stent insertion was successful in 20 patients (91.0%) among<br>the 22 patients treated for palliation. Stent insertion was successfully achieved in 20 patients<br>(80.0%) among the 25 patients. Stent insertion failure was observed in 7 patients (14.9%).<br>Stent failed due to the complete obstruction, 3 patients; long segmental lesion, 1 patient;<br>anatomic abnormality, 1 patient; multiple lesions, 1 patient, and ultra-low rectal lesion, 1<br>patient. Colonoscopy-assisted stent insertion was performed in 5 patients. Post-stent<br>complications occurred in 12 patients among the 40 patients (30.0%): stent migration, 8<br>patients; expansion failure, 2 patients; fecal incontinence, 1 patient; and malposition, 1 patient.<br>The interval between stent insertion and operation was from 1 to 30 days with a median of<br>7 days. Elective operations were performed as follows: anterior resection, 6 patients; low<br>anterior resection, 7 patients; Miles' operation, 3 patients; sigmoid colostomy, 3 patients; and<br>transverse colostomy, 1 patient. Mean distal resection margin of specimen was 2.3 cm. No<br>postoperative complication was seen. Conclusions : Multi-stage operation can be avoided with<br>flexible rectal stent without increasing postoperative complications. Complication rate was<br>relatively high in patients whom stent were inserted for palliative intent. Combined<br>colonoscopy increased the successful rate in difficult cases. Immediate operation should be<br>considered for the patients with long segmental lesion, multiple lesions, ultra-low rectal<br>lesion, and when perforation is suspected.<br>