Large bowel obstruction is a common surgical emergency. In the developed world the most common underlying cause is an occluding colorectal cancer. Unfortunately, emergency surgery for malignant large bowel obstruction is particularly badly tolerated by patients; mortality may be as high as 40%, a ¢gure that drops to less than 5% in elective cases (1). A review of 272 patients presenting as an emergency with colorectal cancer found that this group were more likely to have a stoma fashioned, took longer to become fully ambulatory after their operation, and spent longer in hospital when compared to patients undergoing elective treatment (2). Furthermore, patients were more likely to die both during initial admission and over the subsequent 5 years (2). The reasons for these appalling statistics are seemingly obvious; tumors that present with obstruction tend to be of a higher stage, and only 50% are candidates for a cure. However, while this is true, it cannot represent the whole story because stage-for-stage survival is also reduced (3). Rather, morbidity andmortality is increased in this group because of the considerable systemic disturbance that accompanies malignant large bowel obstruction; the result is a very poor general condition by the time of hospital presentation. Emphasizing this point, patients presenting acutely have twice the frequency of wound infection, 11 times the frequency of renal failure, and 25 times the rate of respiratory complications compared to patients who are operated on

electively (3). It is now well established that poor general condition is the major cause of mortality in patients presenting with malignant large bowel obstruction and far outweighs local factors related to the primary tumor.