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Management of Malignant Large-Bowel Obstruction

Hsu, June M.D., M.P.H.1; Sevak, Shruti M.D.2

doi: 10.1097/DCR.0000000000001441
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CASE SUMMARY: An otherwise healthy 59-year-old man presented to the emergency department with 2 weeks of narrowed stools, 5 days of obstipation, and 1 day of abdominal pain, nausea, and vomiting. Computed tomography revealed an obstructing sigmoid mass without evidence of metastatic disease, and the CEA was 1.2 ng/mL. Flexible sigmoidoscopy confirmed a circumferentially obstructing distal sigmoid neoplasm. Endoscopic stent placement was immediately followed by a firm distended abdomen. An upright radiograph obtained following the procedure demonstrated free intraperitoneal air. An emergent Hartmann procedure was performed for iatrogenic colon perforation in a patient with malignant obstruction and chronic dilation of the proximal colon.

1 Saint Joseph Mercy Hospital Ann Arbor, Ann Arbor, Michigan

2 Center for Colon and Rectal Surgery, Advent Health, Orlando, Florida

Earn Continuing Education (CME) credit online at This activity has been approved for AMA PRA Category 1 Credit.TM

Funding/Support: None reported.

Financial Disclosures: None reported.

Correspondence: June Hsu, M.D., M.P.H., Saint Joseph Mercy Ann Arbor Hospital, 1414 Astor Ave, Ann Arbor, MI 48104. E-mail:

© 2019 The American Society of Colon and Rectal Surgeons