A Study on the Management of Ileus Caused by Cancer in the Left Colon : Colonoscopic Retrograde Bowel Drainage (Decompression) : CRBD

Abstract: As nasal tube insertion is minimally effective for the management of ileus caused by cancer in the left colon, emergency operations are often necessary for such cases. Recently, a new preoperative colonoscopic procedure, designed with the aim of avoiding emergency operations, was invented. This method, termed colonoscopic retrograde bowel drainage (decompression) (CRBD), can be described as follows : After confirming the lesion colonoscopically, the drainage (decompression) tube is inserted beyond the obstructive lesion along a guide wire or dilator. This method was applied in 17 patients (11 males and 6 females), with an average age 66.8 years (range 44-88 years), one with descending colon cancer, 9 sigmoid colon cancer, 5 rectal cancer and 2 Schnitzler metastasis. The interval from CRBD to surgery was 11.5 days. During this period, preoperative examinations and complete preparation of the colon could be performed. This allowed surgery to be performed electively with the patient in satisfactory condition. The most important benefit of CRBD is that a forward view of obstructive lesions can be obtained with a colonoscope. This direct view procedure reduces the risk of complications. Thus, in properly selected cases, CRBD may allow emergency surgery to be avoided. We conclude that CRBD should be attempted as the initial treatment, before proceeding to surgery.