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Colonic stenting for malignant bowel obstruction: Cure or cause?
Digestive and Liver Disease 43 (2011) 416
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Colonic stenting for malignant bowel obstruction: Cure or cause? Floor Catharina Josephina Irene Moenen a,∗ , Adriaan van den Haak b , Lennard Petrus Lucia Gilissen c a
Department of Internal Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands c Department of Gastroenterology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands b
a r t i c l e
i n f o
Article history: Received 28 September 2010 Accepted 19 October 2010 Available online 26 November 2010
1. Clinical presentation A 79-year-old woman was admitted to our hospital with abdominal pain, nausea and vomiting. In 2003 she was diagnosed with an esophageal adenocarcinoma, treated with a transhiatal esophagectomy with gastric tube reconstruction. Recently, she had been admitted because of an ileus, caused by an obstructive process in the descending colon. Histology revealed a metastasis of her primary esophageal carcinoma. A self expandable colonic stent was inserted endoscopically. Now she presented again with abdominal pain. On examination her abdomen was distended and painful, auscultation revealed ileus peristalsis. CT scan of the abdomen showed the stent in the descending colon (Fig. 1). A bowel-within-bowel configuration and contained fat inside was seen, a typical configuration for an intussusception. Endoscopy revealed a stenosis caused by the invaginated bowel. By moving the endoscope through the stenosis, the bowel was repositioned. No recurrent obstruction was seen during the following days of admission. Malignancy is the cause of colonic obstruction in 88–97% of cases. In patients who are no surgical candidates because of severe comorbidities or advanced disease, self-expanding metal stents (SEMS) have been shown to provide durable palliation and improved quality of life [1]. Potential complications of SEMS insertion include perforation, tumour ingrowth, and stent migration. As far as we know, no case of bowel invagination in the stent was described previously.
∗ Corresponding author at: Stationsweg 16, 5611 BX Eindhoven, The Netherlands. Tel.: +31 0614446151. E-mail addresses: fl[email protected] (F.C.J.I. Moenen), [email protected] (A. van den Haak), [email protected] (L.P.L. Gilissen).
Reference [1] Dekovich A. Endoscopic treatment of colonic obstruction. Curr Opin Gastroenterol 2008;25:50–4.
1590-8658/$36.00 © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2010.10.011
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Colonic stenting for malignant bowel obstruction: Cure or cause? Floor Catharina Josephina Irene Moenen a,∗ , Adriaan van den Haak b , Lennard Petrus Lucia Gilissen c a
Department of Internal Medicine, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands Department of Radiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands c Department of Gastroenterology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands b
a r t i c l e
i n f o
Article history: Received 28 September 2010 Accepted 19 October 2010 Available online 26 November 2010
1. Clinical presentation A 79-year-old woman was admitted to our hospital with abdominal pain, nausea and vomiting. In 2003 she was diagnosed with an esophageal adenocarcinoma, treated with a transhiatal esophagectomy with gastric tube reconstruction. Recently, she had been admitted because of an ileus, caused by an obstructive process in the descending colon. Histology revealed a metastasis of her primary esophageal carcinoma. A self expandable colonic stent was inserted endoscopically. Now she presented again with abdominal pain. On examination her abdomen was distended and painful, auscultation revealed ileus peristalsis. CT scan of the abdomen showed the stent in the descending colon (Fig. 1). A bowel-within-bowel configuration and contained fat inside was seen, a typical configuration for an intussusception. Endoscopy revealed a stenosis caused by the invaginated bowel. By moving the endoscope through the stenosis, the bowel was repositioned. No recurrent obstruction was seen during the following days of admission. Malignancy is the cause of colonic obstruction in 88–97% of cases. In patients who are no surgical candidates because of severe comorbidities or advanced disease, self-expanding metal stents (SEMS) have been shown to provide durable palliation and improved quality of life [1]. Potential complications of SEMS insertion include perforation, tumour ingrowth, and stent migration. As far as we know, no case of bowel invagination in the stent was described previously.
∗ Corresponding author at: Stationsweg 16, 5611 BX Eindhoven, The Netherlands. Tel.: +31 0614446151. E-mail addresses: fl[email protected] (F.C.J.I. Moenen), [email protected] (A. van den Haak), [email protected] (L.P.L. Gilissen).
Reference [1] Dekovich A. Endoscopic treatment of colonic obstruction. Curr Opin Gastroenterol 2008;25:50–4.
1590-8658/$36.00 © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2010.10.011