Delayed Colonic Perforation Following Stent Placement for Colorectal Obstruction: A Description of Two Cases with Stent Palliation
Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.
Choo IW, Do YS, Suh SW, Chun HK, Choo SW, Park HS, Kang SK, Kim SK. Malignant colorectal obstruction: treatment with a flexible covered stent. Radiology 1998;206(2):415-21.
Mainar A, Tejero E, Maynar M, Ferral H, Castaneda- Zuniga W.Colorectal obstruction: treatment with metallic stents. Radiology1996;198(3):761-4.
De Gregorio MA, Mainar A, Tejero E, Tobío R, Alfonso E, Pinto I, Fernández R, Herrera M, Fernández JA. Acute colorectalobstruction: stent placement for palliative treatment – result of amulticenter study. Radiology 1998;209(1):117-20.
Canon CL, Baron TH, Morgan DE, Dean PA, Koehler RE.Treatment of colonic obstruction with expandable metal stents:radiologic features. AJR 1997;168(1):199-205.
Mainar A, De Gregorio MA, Tejero E, Tobío R, Alfonso E, Pinto I, Herrera M, Fernández JA. Acute colorectalobstruction: treatment with selfexpandable metallic stents beforescheduled surgery - results of a multicenter study. Radiology 1999;210(1): 65-9.
Wallis F, Campbell KL, Eremin O, Hussey JK. Selfexpandingmetal stents in the management of colorectal carcinoma-a preliminaryreport. Clin Radiol 1998;53(4): 251-4.
Dohmoto M. New method endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva 1991, 3:1507–12.
Laura E. Targownik, Brennan M. Spiegel, Jonathan Sack, Oscar J. Hines, Gareth S. Dulai, MSHS, Ian M. Gralnek, MSHS, James J. Farrell. Colonic stent vs. emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastroint Endosc, 2004; 60:865-74.
Geiger TM, Miedema BW, Tsereteli Z, Sporn E, Thaler K. Stent placement for benign colonic stenosis: case report, review of the literature, and animal pilot data. Int J Colorectal Dis 2008;23(10):1007–12.
Song HY, Kim JH, Shin JH, Kim HC, Yu CS, Kim JC, Kang SG, Yoon CJ, Lee JY, Koo JH, Lee KH, Kim JK, Kim DH, Shin TB, Jung GS, Han YM. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007;39(5):448–54.
Repici A, De Caro G, Luigiano C, Fabbri C, Pagano N, Preatoni P, Danese S, Fuccio L, Consolo P, Malesci A, D'Imperio N, Cennamo V. WallFlexcolonic stent placement for management of malignant colonic obstruction: a prospective study attwo centers. Gastrointest Endosc2008;67(1):77–84.
Shin SJ, Kim TI, Kim BC, Lee YC, Song SY, KimWH. Clinical application of self-expandable metallic stent for treatment of colorectal obstructioncaused by extrinsic invasive tumors. Dis Colon Rectum 2008;51(5):578–83.
Repici A, Fregonese D, Costamagna G, Dumas R, Kähler G, Meisner S, Giovannini M, Freeman J, Petruziello L, Hervoso C, Comunale S, Faroux R. Ultraflexprecision colonic stent placement for palliation of malignant colonic obstruction: a prospectivemulticenter study. Gastrointest Endosc 2007;66(5):920–7.
Fan YB, Cheng YS, Chen NW, Xu HM, Yang Z, Wang Y, Huang YY, Zheng Q. Clinical applicationof self-expandingmetallic stent in the management of acute left-sided colorectal malignantobstruction. World J Gastroenterol 2006;12(5):755–9.
Jost RS, Jost R, Schoch E, Brunner B, DecurtinsM, Zollikofer CL. Colorectal stenting: an effectivetherapy for preoperative and palliative treatment. Cardiovasc Intervent Radiol 2007;30(3):433–40.
Tilney HS, Lovegrove RE, Purkayastha S, Sains PS, Weston-Petrides GK, Darzi AW, Tekkis PP, Heriot AG. Comparison of colonic stenting and open surgery for malignant large bowel obstruction. SurgEndosc 2007;21(2):225–33.
Alcantara M, Serra X, Bombardó J, Falcó J, Perandreu J, Ayguavives I, Mora L, Hernando R, Navarro S. Colorectalstenting as an effective therapy for preoperativeand palliative treatment of the large bowel obstruction:9 years’ experience. Tech Coloproctol 2007;11(4):316-22.
Athreya S, Moss J, Urquhart G, Edwards R,Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications,effectiveness and outcome-5 year review. Eur J Radiol 2006;60(1):91-4.
Soto S, López-Rosés L, González-Ramírez A,Lancho A, Santos A, Olivencia P. Endoscopic treatment of acutecolorectal obstruction withself-expandable metallic stents: experience in acommunity hospital. Surg Endosc 2006;20(2):1072-6.
Keymling M. Colorectal stenting. Endoscopy 1996;35(3):234-8.
Han YM, Lee JM, Lee TH. Delayed colon perforation after palliativetreatment for rectal carcinoma withbare rectal stent: a case report. Korean J Radiol 2000;1(3):169-71.
Breitenstein S, Rickenbacher A, Berdajs D, PuhanM, Clavien PA, Demartines N. Systematic evaluationof surgical strategies for acute malignant leftsidedcolonic obstruction. Br J Surg 2007;94(12):1451–60.
Dionigi G, Villa F, Rovera F, Boni L, Carrafiello G, Annoni M, Castano P, Bianchi V, Mangini M, Recaldini C, Laganà D, Bacuzzi A, Dionigi R. Colonic stentingfor malignant disease: review of literature. Surg Oncol 2007;16:[suppl 1]S153–5.
vanHooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM, Bemelman WA; Dutch Colorectal Stent Group. Dutch Colorectal Stent Group. Early closure of a multicenter randomized clinical trial of endoscopicstenting versus surgery for stage IV leftsidedcolorectal cancer. Endoscopy 2008;40(3):184-91.
Small AJ, Baron TH. Comparison of Wallstentand Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, casematchedanalysis. Gastrointest Endosc 2008;67(3):478–88.
Suzuki N, Saunders BP, Thomas-Gibson S, AkleC, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectalstenting. Dis Colon Rectum 2004;47(7):1201–7.
|Issue||Vol 51, No 10 (2013)|
|Obstruction Perforation Rectal stent|
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