Erschienen in:
01.11.2004 | Case Reports
Delayed Ischemic Cecal Perforation Despite Optimal Decompression After Placement of a Self-Expanding Metal Stent: Report of a Case
verfasst von:
Filip K. Knop, M.D., Bo Pilsgaard, M.D., Søren Meisner, M.D., Peer Wille-Jørgensen, M.D., D.M.Sc.
Erschienen in:
Diseases of the Colon & Rectum
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Ausgabe 11/2004
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Abstract
Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too “old” for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.