Clin Endosc.  2012 Nov;45(4):448-450.

Insertion of Self Expandable Metal Stent for Malignant Stomal Obstruction in a Patient with Advanced Colon Cancer

• Wi JO
• Shin SJ
• Yoo JH
• Choi JW
• Yoo BH
• Lim SG
• Lee KM
• Kim JH

Abstract

Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.

Keyword

Stents; Neoplasms; Stoma

MeSH Terms

Abdominal Pain
Carcinoma
Colon
Colon, Ascending
Colonic Neoplasms
Colorectal Neoplasms
Endoscopy
Humans
Ileostomy
Middle Aged
Palliative Care
Stents

Figure

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  Fig. 1 Computed tomography of the abdomen showed abdominal wall metastasis. Enhancing mass around the ileostomy site resulted in diffuse dilatation of the small bowel.

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  Fig. 2 (A) Conventional endoscopy showed obstruction of the stoma by cancer invasion. (B) The lesion was felt to be hard on palpation and it had shallow, irregular marginated ulcers covered with exudates.

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  Fig. 3 (A) After removing the rectal tube, (B, C) we inserted a guide wire through the obstructive lumen under endoscopy and fluoroscopic guidance. (D) Then, self expandable metallic stent was inserted over the guide wire. (E, F) The last two pictures showed the fully expanding percutaneous metal stent and fecal materials pouring from the stent's lumen.

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  Fig. 4 (A) Fluoroscopic view showed the release of the stent at the obstruction site and (B) the fully expanding stent contrasted by air inflation. Another stent, which had previously been inserted into the ascending colon and migrated was noted above it.

Reference

1. Colwell J. Colwell J, Goldberg M, Carmel J, editors. Stomal and peristomal complications. Fecal and Urinary Diversions: Management Principles. 2004. St. Louis: Mosby;p. 308–325.

2. De Angelo DJ. Chang AE, Hayes DF, Pass HI, editors. Metabolic emergencies in oncology. Oncology: an Evidence-Based Approach. 2006. 1st ed. New York: Springer-Verlag;p. 1321–1331.

3. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002; 89:1096–1102. PMID: 12190673.

4. Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007; 246:24–30. PMID: 17592286.

5. Choo IW, Do YS, Suh SW, et al. Malignant colorectal obstruction: treatment with a flexible covered stent. Radiology. 1998; 206:415–421. PMID: 9457194.

6. Law WL, Chu KW, Ho JW, Tung HM, Law SY, Chu KM. Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum. 2000; 43:1522–1527. PMID: 11089586.

7. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998; 41:1562–1572. PMID: 9860339.

8. Roberts PL, Veidenheimer MC, Cassidy S, Silverman ML. Adenocarcinoma arising in an ileostomy: report of two cases and review of the literature. Arch Surg. 1989; 124:497–499. PMID: 2539068.

9. Carey PD, Suvarna SK, Baloch KG, Guillou PJ, Monson JR. Primary adenocarcinoma in an ileostomy: a late complication of surgery for ulcerative colitis. Surgery. 1993; 113:712–715. PMID: 8506531.

10. Orkin BA, Araghizadeh F. Billingham RP, Kobashi KC, Peters WA, editors. Reoperative surgery for gastrointestinal stomal problems. Reoperative Pelvic Surgery. 2009. 1st ed. New York: Springer-Verlag;p. 289–305.

11. Baron TH, Dean PA, Yates MR 3rd, Canon C, Koehler RE. Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes. Gastrointest Endosc. 1998; 47:277–286. PMID: 9540883.

12. Kim ID, Kang DH, Choi CW, et al. Prevention of covered enteral stent migration in patients with malignant gastric outlet obstruction: a pilot study of anchoring with endoscopic clips. Scand J Gastroenterol. 2010; 45:100–105. PMID: 20030581.