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Spine complications of stent placement
At the Focal Point...
SPINE COMPLICATIONS OF STENT PLACEMENT
B
A A 62-year-old man was found to have squamous cell cancer of the proximal esophagus 1 year before referral to us. He had undergone extensive combined chemotherapy and radiotherapy, frequent and repeated esophageal bougienage, and placement of a gastrosVOLUME 55, NO. 2, 2002
tomy tube. A previously placed self-expanding metal stent (Ultraflex II, Microvasive Endoscopy, Natick, Mass.) had been removed 4 months earlier because of a foreign body sensation. Because of an inability to handle his secretions, another self-expandable metal stent (Ultraflex II) was placed. He did well for about 4 weeks but then returned with complaints of severe neck pain and a cough productive of greenish sputum. Evaluation included magnetic resonance imaging of the neck that demonstrated changes in the C6 and C7 vertebral bodies and the intervertebral disk consistent with osteomyelitis and diskitis, respectively (A). CT revealed air in the spinal canal consistent with an epidural abscess (B). An attempt to remove the stent was unsuccessful and was terminated because of respiratory difficulty during the procedure, at which time bilateral vocal cord palsy was also noted. The patient died of respiratory complications 5 days after refusing intubation and a further attempt at stent retrieval. Joseph V. Mersol, MD, PhD Richard A. Kozarek, MD Virginia Mason Medical Center Seattle, Washington doi:10.1067/mge.2002.120812 GASTROINTESTINAL ENDOSCOPY
241
SPINE COMPLICATIONS OF STENT PLACEMENT
B
A A 62-year-old man was found to have squamous cell cancer of the proximal esophagus 1 year before referral to us. He had undergone extensive combined chemotherapy and radiotherapy, frequent and repeated esophageal bougienage, and placement of a gastrosVOLUME 55, NO. 2, 2002
tomy tube. A previously placed self-expanding metal stent (Ultraflex II, Microvasive Endoscopy, Natick, Mass.) had been removed 4 months earlier because of a foreign body sensation. Because of an inability to handle his secretions, another self-expandable metal stent (Ultraflex II) was placed. He did well for about 4 weeks but then returned with complaints of severe neck pain and a cough productive of greenish sputum. Evaluation included magnetic resonance imaging of the neck that demonstrated changes in the C6 and C7 vertebral bodies and the intervertebral disk consistent with osteomyelitis and diskitis, respectively (A). CT revealed air in the spinal canal consistent with an epidural abscess (B). An attempt to remove the stent was unsuccessful and was terminated because of respiratory difficulty during the procedure, at which time bilateral vocal cord palsy was also noted. The patient died of respiratory complications 5 days after refusing intubation and a further attempt at stent retrieval. Joseph V. Mersol, MD, PhD Richard A. Kozarek, MD Virginia Mason Medical Center Seattle, Washington doi:10.1067/mge.2002.120812 GASTROINTESTINAL ENDOSCOPY
241