2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation

Abstract

Keywords * Colon * Rectum * Cancer * Obstruction * Perforation * Emergency Background In 2010, the World Society of Emergency Surgery (WSES) published the guidelines for the management of obstructive left colon cancer [1]. A word of caution must be spent with regards to the increasing incidence of CRC in the population younger than 50 years: this could potentially encourage an update in screening programs [4, 5]. * Complications of large bowel diseases account for 47% of gastrointestinal emergencies [6]. * CRC presents as emergency in a wide range of patients (from 7 to 40% of the total), but the vast majority of reports present a figure of around 30% [6–15]. * Large bowel obstruction (LBO) represents almost 80% (15–30% of CRC) of the emergencies related to CRC, while perforation accounts for the remaining 20% (1–10% of CRC) [7, 12, 16, 17]. * The most common location of CRC obstruction is the sigmoid colon, with 75% of the tumours located distal to the splenic flexure [18]. * Perforation occurs at the tumour site in almost 70% of cases and proximal to the tumour site in around 30% of cases [6, 19, 20]. Materials and methods: consensus conference organisational model In July 2016, the Scientific Board of the WSES endorsed the President of the Society and the President of the 4th World Congress of the WSES to prepare the Consensus Conference on Colon Rectal Cancer Emergencies (CRCE) focusing on obstruction and perforation. Table 1 Questions and MeSH terms Questions Key words Diagnosis diagnosis, cancer, neoplasm, colon, rectum, bowel, perforation, obstruction, physical examination, radiology, laboratory, abdominal ultrasound, CT scan, colonic enema Perforation perforation, cancer, neoplasm, colon, rectum, bowel, tumour perforation, diastatic perforation, faecal peritonitis, treatment, surgery, acute care surgery Obstruction left obstruction, left colon, rectum, cancer, neoplasm, surgery, acute care surgery, stent, SEMS, Hartmann’s procedure, colostomy, resection, anastomosis, tube decompression Obstruction right obstruction, right colon, rectum, neoplasm, surgery, acute care surgery, stent, SEMS, loop ileostomy, intestinal bypass, resection, anastomosis, tube decompression Unstable patients unstable patient, haemodynamic instability, critically ill patient, sepsis, peritonitis, obstruction, cancer, neoplasm, colon, rectum, surgery, acute care surgery, damage control, open abdomen.