In left-sided obstructing colon cancer, cecal dilation ≥9 cm plus small-bowel distention on CT identified patients with worse outcomes after emergency resection—and may help guide consideration of bridge-to-surgery.

• After emergency resection, complications occurred in 58.8% of patients with both CT findings versus 42.7% without; 30-day mortality was 7.0% versus 2.7%.
• In this high-risk subgroup, bridge-to-surgery was associated with fewer complications (37.4% vs 58.8%), fewer permanent stomas (23.0% vs 52.1%), and more primary anastomoses (85.4% vs 30.6%).

This observational comparison cannot establish that bridge-to-surgery caused better outcomes, but the CT pattern may inform individualized planning.