What is the appropriate management for patients with large bowel obstruction due to carcinoma above the peritoneal reflection?

The appropriate management for patients with large bowel obstruction due to carcinoma above the peritoneal reflection is resection. In cases of malignant large bowel obstruction, particularly when the carcinoma is located above the peritoneal reflection, resection of the affected segment is often necessary to remove the tumor and potentially address the obstruction effectively. This approach not only alleviates the obstruction but also provides an opportunity to manage the underlying malignancy.

Performing a resection allows for both the removal of the cancerous tissue and any involved lymph nodes, which is crucial for staging and treatment planning. Additionally, resection can help prevent future obstructions and complications associated with malignancies in the bowel.

Other management options, such as stenting or defunctioning, may be more appropriate in certain scenarios, like palliation in advanced disease or cases where immediate surgery poses a high risk. However, in the case of a resectable tumor with obstruction above the peritoneal reflection, the most definitive and appropriate approach is surgical resection. Observation is generally not considered adequate in cases of malignant obstruction, as it does not address the underlying cause nor alleviate the patient's immediate issue.