الفهرس 
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Abstract
Bowel obstruction occurs when the normal flow of intraluminal contents is blocked. Large bowel obstruction constitutes approximately 25 percent of all intestinal obstructions. Colorectal cancer (60 percent), volvulus (15 to 20 percent), and diverticular disease (10 percent) are the most common causes of large bowel obstruction.
Patients identified with acute mechanical large bowel obstruction should be admitted to the hospital. Initial supportive care includes bowel resection, intravenous fluid therapy with correction of electrolyte abnormalities, and gastrointestinal decompression for those with nausea or vomiting. Subsequent treatment depends upon the etiology and location of the obstruction, the medical comorbidities of the patient, and the local resources and expertise of the available clinicians.
Perioperative (30 day) morbidity and mortality for obstructing lesions are similar for benign versus malignant pathology, though for oncologic reasons long-term mortality is worse for malignant obstruction. Patients undergoing emergency surgery for colorectal malignancies have significantly worse outcomes than those undergoing elective resection.
The current study was conducted at Beni-Suef University Hospitals aiming to evaluate the efficacy and safety of emergency resection in patients with colonic cancer presenting with acute bowel obstruction. We included a total of 20 patients diagnosed with obstructed cancer colon who underwent surgical intervention for the condition.
All patients were subjected to complete history taking, thorough clinical examination and routine preoperative laboratory investigations including tumor markers (CEA and CA 19-9). Additionally, radiological investigations included abdominal X-ray, pelviabdominal ultrasound and pelviabdominal CT.
The study showed the following findings:
• The mean age of the included cases was 58.25 years (range, 49 – 69).
• Their BMI ranged between 24.3 and 35.3 kg/m2 (mean = 28.5 kg/m2).
• Males represented 60% of the included patients, whereas the remaining patients were females.
• Smokers represented 20% of the study population (four cases).
• Diabetes mellitus and hypertension were detected in 25% and 15% of the study participants respectively.
• Previous abdominal surgeries were reported by three patients (15%).
• Family history of colorectal cancer was reported by only one patient (5%).
• The duration of obstructing symptoms ranged between two and five days.
• Preoperative radiological investigations revealed normal liver in the 95% of patients, and only one patient had early parenchymatous liver diease.
• Sigmoid colon was the commonest affected site (50%), followed by descending colon (25%), hepatic flexure (20%), and caecum (5%).
• Total leucocytic count ranged between 8.4 and 16.8x103/ml.
• CEA had a mean value of 8.01 ng/ml, while CA19-9 had a mean value of 35 U/ml.
• On surgical exploration, the size of the obstructing mass ranged between five and 12 cm.
• Sigmoidectomy was the commonest performed resection (50%), followed by left hemicolectomy (25%), extended right hemicolectomy (20%), and right hemicolectomy (5%).
• For right sided lesions, primary anastomosis was performed (five cases – 25%), while patients with left sided lesions had double barrel colostomy.
• Intraoperative blood loss ranged between 175 and 380 ml (mean = 271.25 ml).
• Intraoperative blood transfusion was required in two patients (10%).
• Operative time ranged between 90 and 131 minutes (113.7 minutes).
• The included patients were allowed to start oral fluid on the second to the fifth post-operative day.
• The duration of hospitalization had a mean value of 5.2 days (range, 4 – 7).
• Classic adenocarcinoma was the commonest encountered pathology (85%), followed by mucoid adenocarcinoma (10%), while signet ring adenocarcinoma was detected only in one patient (5%).
• Most tumors were highly differentiated (70%), while moderate and low differentiated ones were detected in 15% of cases for each type.
• The number of resected lymph nodes ranged between 11 and 20 nodes (mean = 14.65), while the number of infiltrated nodes had a mean value of 5.7.
• Lymph node ratio ranged between 0.21 and 0.64 (mean = 0.4).
• Lymphovascular invasion was detected in 20% of patients.
• All surgical cut margins were free from malignancy in the current study.
• Post-operative paralytic ileus was encountered in four patients (20%), while wound infection was detected in six patients (30%).
• Post-operative fever was encountered in 35% of patients, while chest infection was detected in 10% of the study population.
• NO cases with anastomotic leakage in patients with primary anastomosis, and no stomal complications were detected in the remaining diverted cases except one case of stomal congestion which resolved spontanously.