Aim. To evaluate the effectiveness of surgical treatment for elderly and senile patients with acute malignant colonic obstruction using a differentiated approach to the choice of tactics based on the data of additional instrumental methods of examination.

Materials and methods. The surgical treatment results of 122 patients aged 65–89 years with acute malignant colonic obstruction treated at the Surgical Department of the Municipal Non-Profit Enterprise “City Hospital No. 9” of the Zaporizhzhia City Council between 2022 and 2024 were analyzed. The diagnostic protocol included contrast-enhanced computed tomography, colonoscopy, plain abdominal radiography, abdominal ultrasonography, and intra-abdominal pressure measurement.

Results. Computed tomography was performed as the gold standard of diagnosis and enabled precise identification of tumor location, degree of obstruction, lymph node involvement, and signs of intestinal ischemia (wall thickening, lack of contrast) as well as potential complications (perforation, abscess, peritonitis) in all patients examined. Colonoscopy confirmed tumor topography and provided histological verification of the diagnosis. Measurement of intra-abdominal pressure complemented the examination complex, correlating with abdominal hypertension severity. The use of minimally invasive methods (endoscopic stenting and laparoscopy) showed favorable treatment results, allowing effective elimination of the obstruction and, after stabilization of the condition, radical resection with primary anastomosis.

Conclusions. Early multimodal diagnosis combined with an individualized surgical approach improves the effectiveness of treatment for older patients with acute malignant colonic obstruction. The use of minimally invasive techniques (stenting and laparoscopy) enables resection with primary anastomosis in a substantial proportion of patients, reduces stoma formation rates, and increases the quality of patients’ life.