Synopsis
Select appropriate malignant colonic obstruction for stenting, explain the different aims of a bridge and palliation, and recognise when failure requires urgent surgical treatment.
- Reserve a colonic stent for symptomatic, radiologically confirmed malignant obstruction after assessment excludes perforation and other reasons for immediate surgery.
- Discuss bridging stenting alongside emergency resection for suitable potentially curable left-sided colon cancer; include perforation, failure, stoma and oncological trade-offs.
- Palliative stenting is often preferred for a suitable malignant obstruction, but new severe pain, guarding or shock after placement demands urgent assessment for perforation.
Key red flags
Perforation, peritonitis, systemic toxicity or convincing bowel infarction makes routine stenting inappropriate. A stent does not remove gangrenous bowel or control faecal contamination. Escalate urgently when these features emerge before or after the procedure.
Investigation priorities
Confirm malignant obstruction and decide whether the anatomy and bowel condition support stent placement.
Management branches
A patient has symptomatic malignant large-bowel obstruction being considered for a stent.
- Review contrast CT and the patient together. Exclude perforation, peritonitis and convincing ischaemia or systemic deterioration that requires surgery; do not insert a prophylactic stent into an asymptomatic narrowing.
- For a suitable stable patient, agree whether the purpose is a bridge or palliation and discuss alternatives with the colorectal team. Include technical failure, perforation, emergency surgery and the possibility of a stoma before the procedure begins.