Emergency Surgical Management of Malignat Large Bowel Obstruction

Ahmedou Moulaye DRISS, MD. Faculty of Medicine of Nouakchott

Background: Majority of cases of acute large bowel obstruction are related to cancer. In Mauritania more than 40% of patients with colorectal cancer (CRC) present with symptoms of acute obstruction. There is a significant risk of mortality and morbidity in emergency surgery for acute colonic obstruction and large number of patients will have a colostomy.

Patients and Methods: From January 2008 to December 2014, 150 cases of CRC are managed in two institutions. Were included all patients with acute large bowel obstruction operated within this period. Were excluded all cases with no malignancy. In this retrospective study sixty files analyzed statistically by SPSS system.Variables wereage,gender,ethnicity, history,clinical,biology,sndoscopy,Imaging,surgery,complications,pathology, chemotherapyand length of stay

Results: There were 42(70%) men 18(30%) women. Mean age 49(23-72y) years. Arab-Berber ethnic group (90%).History: tobacco(10%),diarrhea and/or constipation20%. Occlusive syndrome present in all patients including pain,bloating,nausea and vomiting. Abdomen X-ray and Ultrasound are contributory 50%. CT-Scann 60%. Operative risk ASAIII 30%. All patients underwent surgical emergency. 18(30%) simple colostomy, primary colonic resection 42(70%) cases. There were 6(10%) diastatic perforation and 3(5%) iatrogenic perforation. Biopsy with endoscopy was 18(30%) cases. Tumor seat was right colon 12(20%) cases and left 36(60%) patients.Rectal seat 20%.Transfusion required in 12 patients. Synchronous liver metastasis in 10%. Mortality rate was 20% and morbidity 30% (20% infection, 2 cases ureteral ligation). Carcinomatosis 20%. Length of stay 12 days (7-19d). 30% of free margin section and adenocarcinoma were the most frequent (95%). overall 5 years survival was 10% and 30% after 3years. Recurrence observed 18(30%) times. Adjuvant chemotherapy performed 20% patients.

Conclusion: Despite significant progress,the management of acute colonic obstruction still remains a challenge as well as both in developed and developing countries.The primary resection was the most common procedure option in our study.In our country the poverty of our technical platform and especially the lack of availability of stent use in our context may explain the mortality and morbidity rates high in our study.

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