Self-expanding metallic stents for acute left-sided large-bowel obstruction: a review of 130 patients

Colorectal Dis. 2011 May;13(5):549-54. doi: 10.1111/j.1463-1318.2010.02216.x.


Aim: The aim of this study was to evaluate the outcomes of self-expanding metallic stent (SEMS) placement in acute left-sided large-bowel obstruction.

Method: From 1997 to 2008, 130 patients [mean 67 (SD 14.7)] underwent SEMS insertion for acute left-sided large-bowel obstruction. One-hundred and one procedures were palliative, and 29 patients underwent stent insertion as a bridge for surgery. The success rate and the outcome were analysed.

Results: The chief causes of obstruction were primary (67%) and recurrent (16%) colorectal carcinoma. The success rate was 88% after insertion of the first stent. In nine patients, insertion of a second stent was required. Complications occurred in 20% of the insertions, with migration (10.8%) being the most common. Perforation occurred in two patients and one developed a colovesical fistula. In patients with palliative stenting, 14 (13.9%) required subsequent surgery, with a stoma placed in all except three. Among the 29 patients who underwent SEMS insertion as a bridge to surgery, subsequent surgical resection was performed in 26 patients at a mean interval of 12 days (SD 18.0). Primary anastomosis was performed in 24 patients. The mean survival for those who underwent SEMS insertion as a bridge to surgery was 40 (95% confidence interval: 24-55) months.

Conclusion: SEMS placement is safe and effective in relieving acute left-sided colonic obstruction. It allows subsequent definitive surgery on an elective setting and also serves as good palliation for advanced or disseminated disease.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colonic Diseases / etiology
  • Colonic Diseases / therapy*
  • Female
  • Humans
  • Intestinal Obstruction / etiology*
  • Intestinal Obstruction / therapy*
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Palliative Care
  • Rectal Diseases / etiology
  • Rectal Diseases / therapy*
  • Stents* / adverse effects
  • Treatment Outcome