| The management of obstructing or perforated | | | | provided the bowel is not dilated and appears |
| colon cancer presents unique considerations.When | | | | relatively healthy. |
| patients present with urgent evidence of | | | | Perforations at the tumor site can present either |
| obstruction without the opportunity to prepare | | | | as locally contained abscesses or as free |
| the bowel, they must be expediently resuscitated | | | | perforation with peritonitis. In addition, obstructing |
| and undergo immediate surgical exploration. If the | | | | tumors can result incolonic perforation, typically |
| obstruction is due to a proximal lesion near the | | | | proximal to the tumor or at the cecum. In the |
| ileocecal valve, a right hemicolectomy with | | | | case of contained perforations, abscesses can be |
| primary anastomosis may be performed safely in | | | | drained percutaneously with subsequent |
| most cases, even with an unprepared colon. More | | | | investigationsand elective surgical management. |
| distal obstructions are problematic because the | | | | Free perforation with peritonitis is a surgical |
| proximal colon is dilated and typically full of stool. | | | | emergency that necessitates rapid resuscitation |
| Once the involved segment of colon is resected, | | | | and operation. In the setting of gross fecal |
| ontable lavage can be performed. This involves | | | | contamination, resection of the tumor and |
| mobilization of the colon, attachment of large bore | | | | perforation are performed when possible with a |
| sterile tubing to drain the effluent, and instillation of | | | | proximal colostomy or ileostomy (Hartmann’s |
| a large volume of warm saline through a catheter | | | | procedure). In some cases, a primary |
| placed through an appendicostomyor the terminal | | | | anastomosis can be performed with a protecting |
| ileum. The distal segment of bowel can be | | | | proximal ostomy. An unprotected anastomosis |
| washed out from below. This technique can allow | | | | without diversion is ill advised in these unstable |
| for a primary anastomosis in some cases | | | | patients. |