Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Bowel obstruction, cholangitis or sepsis during metastatic treatment
Distension with vomiting and obstipation, jaundice with fever and rigors, or acute deterioration during systemic therapy needs same-day assessment rather than waiting for response imaging.
Action: Begin ABCDE care, obtain intravenous access, cultures, full blood count, renal and liver tests, lactate and blood-bank samples as indicated. Use urgent contrast CT for obstruction and hepatobiliary imaging for biliary sepsis; involve colorectal, hepatobiliary, acute oncology and anaesthetic teams for decompression, drainage, antibiotics and source control.
Synopsis
Recognise potentially treatable colorectal metastases, obtain complete anatomical and molecular staging, and refer liver-limited or oligometastatic disease early to a specialist multidisciplinary team before declaring it unresectable.
Liver is the commonest metastatic site because portal venous drainage carries tumour cells from the colon.
Resectability depends on clearing all disease while preserving an adequate functioning liver remnant, not simply lesion number.
High-quality liver imaging defines segmental relationships to vessels and remaining parenchyma.
Key red flags
Distension with vomiting and obstipation, jaundice with fever and rigors, or acute deterioration during systemic therapy needs same-day assessment rather than waiting for response imaging.
Investigation priorities
01
Contrast CT chest, abdomen and pelvisFirst step
Stage the primary, liver, lung, peritoneum and nodes as one disease process.
Management branches
Worked case: unilobar liver-limited metastasesPreserve curative options through joint colorectal and liver planning
A fit 62-year-old has a non-obstructing sigmoid adenocarcinoma and three colorectal metastases confined to liver segments V, VI and VII. CT shows no extrahepatic disease and bilirubin is normal.
Complete colonoscopy, primary-tumour biopsy, CT staging and liver MRI, which confirms three right-sided deposits clear of the left inflow, outflow and biliary drainage.
Obtain RAS, BRAF V600E and MMR results and discuss the same images at colorectal and specialist hepatobiliary MDTs before either team starts an irreversible treatment sequence.
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 7 Sept 2026; clinical approval remains outstanding.