Internal Ileosigmoid Bypass as a Stoma-sparing Strategy for Unresectable Malignant Transverse Colonic Obstruction: A Case Report and Review of the Literature

Abstract

Introduction: Malignant large bowel obstruction is a life-threatening complication of advanced colorectal cancer. When curative resection is not feasible, palliative surgery aims to relieve obstruction while preserving quality of life. Internal intestinal bypass is an uncommon but effective alternative to a diverting stoma in selected patients. Case Presentation: A 41-year-old woman with unresectable stage IV transverse colon adenocarcinoma presented with acute malignant large bowel obstruction. Emergency laparotomy revealed a fixed tumour invading the root of the mesentery, precluding curative resection. A side-to-side ileosigmoid bypass was performed between the terminal ileum and the rectosigmoid junction, successfully restoring intestinal continuity without stoma formation. The postoperative course was uneventful. Clinical Discussion: Internal intestinal bypass provides effective palliation in selected patients with unresectable colorectal cancer by relieving obstruction while avoiding stoma-related morbidity. It may also facilitate early recovery and subsequent systemic treatment. Conclusion: Side-to-side ileosigmoid bypass is a safe and feasible palliative option for unresectable transverse colon cancer presenting with acute malignant large bowel obstruction when resection is not possible.