Insertion of self expandable metal stent for malignant stomal obstruction in a patient with advanced colon cancer

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.

Keywords: Neoplasms; Stents; Stoma.

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.

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.

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.

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.