Malignant colonic obstruction. Diagnostic and therapeutic strategy

Bulgarian Medical Journal, 2025, 19(1), 42-46.

P. Chernopolsky, H. Nikov

Second Department of Surgery, University Hospital „Sv. Marina“ – Varna

Abstract. Intestinal obstruction (with or without) perforation is still a serious problem for surgeons, gastroenterologists, and endoscopists. Over 50% of colonic obstructions are malignant in nature, with colorectal cancer being the most common cause leading to ileus. Aim: To analyze the clinical characteristics, diagnostic and therapeutic procedures and outcome of patients with malignant colonic ileus; to identify risk factors associated with complications and poor prognosis. Material and Results. Retrospective analysis of patients hospitalized in the Second Department of Surgery over a period of 20 years was made. 676 patients (mean age was 64,6 years) were admitted. In 87% the obstruction was only of the colon, in the remaining cases there was also involvement of small bowel segments. Concomitant perforation was seen in 94 (14%) patients. Peritonitis was seen in 59 (8.7%) patients. Of great importance for the exact diagnosis were: ultrasound, radiography and CT. Operative intervention with radical resection was performed in 506 patients – 74,8% (in 24% extended intestinal resection). Palliative interventions were performed in 170 patients (25.2%) – tumor resection + stoma or stoma only. 32 patients were treated conservatively, followed by elective surgery in 24 patients. Concomitant pathology was found in more than 60% of those hospitalized, which explains the complication rate of 26.9% and the postoperative lethality rate of 5.6%. Conclusion: Initial colostomy followed by surgical resection is a technically straightforward strategy, allowing initial abdominal exploration and performance of elective radical intervention and adequate oncologic lymphadenectomy. In the case of right-sided localization of the tumor process, radical surgical resection and primary anastomosis is preferred. Primary anastomosis in left-sided colonic ileus should be applied in strictly selected patients. The results suggest that in advanced obstruction and high-risk patients Hartmann‘s operation should be preferred.

Key words: Key words: malignant colonic ileus/clinical characteristics, diagnostic, therapeutic procedures, outcome

Address for correspondence: Assoc. Prof. P. Chernopolsky, DSc, Second Department of Surgery, University Hospital „St. Marina”, 1 Hr. Smirnenski Blvd., Varna, e-mail: