Abstract
The treatment for acute obstruction caused by left-sided colorectal carcinoma remains controversial in comparison with that for the right side. Several approaches have been performed to remove the colonic obstruction, including emergency surgery with intra-operative colonic lavage, elective surgery followed by preoperative intestinal decompression using a transanal drainage tube or metallic stent. However, emergency surgery is reported to be associated with a higher risk of mortality and morbidity, and the emergency operation without preoperative intestinal decompression should be avoided as much as possible. Although many surgeons have showed some effectiveness of preoperative intestinal decompression by transanal drainage tube before colonic resection, some severe complications such as ulcer formation or colonic perforation could occur while detaining placing the drainage tube. Control of the drainage tube with an appropriate procedure is necessary. New strategies, such as laparoscopic surgery followed by preoperative intestinal decompression, or an investigation of the oral side of the colon using CT-colonoscopy, are required and should be developed.
