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n CME : Your SA Journal of CPD - Advances in the treatment of malignant large-bowel obstruction : main article
- Malignant colonic obstruction carries a high mortality rate.
- The priorities of treatment are fluid resuscitation and decompression of the upstream bowel.
- Right-sided obstructing lesions are usually treated by a right hemicolectomy and primary anastomosis.
- Colonic stenting offers a safe, minimally invasive approach to decompressing the obstructed colon.
- Colonic stenting may be done as definitive palliation, or as a 'bridge to surgery'.
- Several operative strategies exist for left-sided colonic obstruction, and the choice of procedure depends on the general condition of the patient, and the surgeon's experience.
- In an unstable patient, or when the surgeon is inexperienced in major colonic surgery, a defunctioning colostomy is a safe option for emergency decompression of the bowel.
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