Malignant large bowel obstructions (LBO) present a unique and often challenging problem that requires thoughtful consideration of both short and long-term outcomes. Presentations can vary, but the patient will often need urgent or emergent intervention. Primary colorectal cancer accounts for the majority of malignant LBOs making this topic particularly important for the colon and rectal surgeon. Currently there are 3 main treatment strategies for potentially curable disease: Fecal diversion, primary resection with or without diversion, or colonic stent placement followed by elective resection. Stenting is also being used in palliative circumstances. The following chapter outlines the latest literature in malignant LBOs and provides algorithms for both emergent and elective cases. (C) 2019 Elsevier Inc. All rights reserved.