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文献考察（GR４の文献を再掲載）：穿孔の危険性の高い大腸閉塞。１．壁内気腫（１）、２.盲腸の最大径＞１２cm（１）、３．小腸拡張がない（２）。
１）Abdom Imaging. 2003 Mar-Apr;28(2):267-75. Helical CT of large bowel obstruction. Taourel P, Kessler N, Lesnik A, Pujol J, Morcos L, Bruel JM.
２）Ann Surg Oncol. 2002 Jul;9(6):574-9. Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review. Dauphine CE, Tan P, Beart RW Jr, Vukasin P, Cohen H, Corman ML.
BACKGROUND: The purpose of this study was to review our experience with self-expanding metal stents as the initial interventional approach in the management of acute malignant large-bowel obstruction. METHODS: Twenty-six patients who underwent placement of colonic stents at our institution between June 1994 and June 2000 were identified and reviewed. RESULTS: In 14 patients, the stents were placed for palliation, whereas in 12, they were placed as a bridge to surgery. In 22 patients (85%), stent placement was successful on the first occasion. In the remaining four individuals, one was successfully stented at the second occasion, and three required emergency surgery. Nine of the 12 patients (75%) in the bridge-to-surgery group underwent elective colon resection. In the palliative group, four patients (29%) had reobstruction of the stents, and in one (9%), the stent migrated. In the remaining nine patients (64%), the stent was patent until the patient died or until the time of last follow-up (median, 156 days). CONCLUSIONS: In our experience with 26 patients who developed a complete bowel obstruction as a consequence of a malignant tumor, placement of colonic stents to achieve immediate nonoperative decompression proved to be both safe and effective. Subsequent elective resection was accomplished in the majority of resectable cases. PMID: 12095974
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