Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 19: A 68-Year-Old Male With Significant Comorbidities Presented With Weight Loss And New Onset Vomiting. Investigation Showed Colonic Obstruction With Poorly Differentiated Adenocarcinoma Involving The Sigmoid Colon. Do I Consider Stenting? (continued)

Todd H. Baron, MD, FASGE

The short answer to this question is absolutely yes, you should consider placement of a self-expandable metal stent for this patient. But before we get to that definitive recommendation, you must first recognize that acute, complete colonic obstruction is a medical emergency and doing nothing is not an option. It is a medical emergency because colonic perforation may occur from distension of the cecum and/or ischemia of the right colon. Your options in this case are to place a colonic stent, surgical ileostomy, or colostomy (with or without resection of the sigmoid mass), and percutaneous…