CLINICAL IMAGE
Colonic stenting in malignant large bowel obstruction Vinita A. Rajadurai & Michael Levitt Colorectal Surgical Unit, St John of God, Subiaco Hospital, 12 Salvado Road, Subiaco, Western Australia 6008, Australia
Correspondence Vinita A. Rajadurai, Colorectal Surgical Unit, St John of God, Subiaco Hospital, 12 Salvado Road, Subiaco Western Australia 6008, Australia. Tel: +61452486774; Fax: +6189382 9888; E-mail: [email protected] Funding Information No sources of funding were declared for this study.
Key clinical message In patients who are surgical candidates, colonic stenting is beneficial for preoperative decompression in large bowel obstruction, as it can convert a surgical procedure from an emergent two-step approach into an elective one-step resection with a primary anastomosis. Keywords Colon, metallic stent, obstruction, outcome.
Received: 13 January 2016; Revised: 5 November 2015; Accepted: 20 March 2016 Clinical Case Reports 2016; 4(6): 616–617 doi: 10.1002/ccr3.560
A 63-year-old gentleman presented with a 6-week history of gradually worsening lower abdominal colic associated with nausea, abdominal distention, and
altered bowel habit. Background medical history included asthma and bronchiectasis with frequent chest infections.
(A)
(B)
(C)
Figure 1. (A) Computed tomography (CT) of the abdomen and pelvis. (B) Colonic stenting under fluoroscopic guidance. (C) Macroscopic view of resected descending colon.
616
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
V. A. Rajadurai & M. Levitt
CT of abdomen and pelvis revealed a large bowel obstruction with an obstructing mass demonstrating typical apple-core appearances at the level of the mid-descending colon (sagittal view) accompanied by pneumatosis coli of the cecum and ascending colon (coronal view) (Fig. 1a). At urgent colonoscopy, successful decompression of the bowel was achieved using a metallic stent (WallFlex Colonic 90 mm 9 25 mm) placed across the malignant stricture into the proximal colon under fluoroscopic guidance (Fig. 1b). He was seen by his respiratory physician for medical optimization prior to elective resection performed 10 days after stent deployment without the use of a stoma. Histopathology of the resected specimen (Fig. 1c) demonstrated a low-grade adenocarcinoma, T3b N1b. He made a smooth recovery and has since commenced adjuvant chemotherapy. In colonic cancer, surgical morbidity and mortality are substantially higher for emergent surgery than for elective cases [1]. In the case described, preoperative
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Colonic stenting in malignant large bowel obstruction
decompression of the obstructing tumor by deployment of a stent allowed for appropriate optimization of his medical status as well as standard bowel preparation prior to surgery with minimal delay. This resulted in him undergoing a semi-elective, one-stage resection without stoma construction, minimizing delay in the institution of subsequent adjuvant chemotherapy.
Conflict of Interest None declared. Reference 1. Leitman, I. M., J. D. Sullivan, D. Brams, and J. J. DeCosse. 1992. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg. Gynecol. Obstet. 174:513.
617
Colonic stenting in malignant large bowel obstruction Vinita A. Rajadurai & Michael Levitt Colorectal Surgical Unit, St John of God, Subiaco Hospital, 12 Salvado Road, Subiaco, Western Australia 6008, Australia
Correspondence Vinita A. Rajadurai, Colorectal Surgical Unit, St John of God, Subiaco Hospital, 12 Salvado Road, Subiaco Western Australia 6008, Australia. Tel: +61452486774; Fax: +6189382 9888; E-mail: [email protected] Funding Information No sources of funding were declared for this study.
Key clinical message In patients who are surgical candidates, colonic stenting is beneficial for preoperative decompression in large bowel obstruction, as it can convert a surgical procedure from an emergent two-step approach into an elective one-step resection with a primary anastomosis. Keywords Colon, metallic stent, obstruction, outcome.
Received: 13 January 2016; Revised: 5 November 2015; Accepted: 20 March 2016 Clinical Case Reports 2016; 4(6): 616–617 doi: 10.1002/ccr3.560
A 63-year-old gentleman presented with a 6-week history of gradually worsening lower abdominal colic associated with nausea, abdominal distention, and
altered bowel habit. Background medical history included asthma and bronchiectasis with frequent chest infections.
(A)
(B)
(C)
Figure 1. (A) Computed tomography (CT) of the abdomen and pelvis. (B) Colonic stenting under fluoroscopic guidance. (C) Macroscopic view of resected descending colon.
616
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
V. A. Rajadurai & M. Levitt
CT of abdomen and pelvis revealed a large bowel obstruction with an obstructing mass demonstrating typical apple-core appearances at the level of the mid-descending colon (sagittal view) accompanied by pneumatosis coli of the cecum and ascending colon (coronal view) (Fig. 1a). At urgent colonoscopy, successful decompression of the bowel was achieved using a metallic stent (WallFlex Colonic 90 mm 9 25 mm) placed across the malignant stricture into the proximal colon under fluoroscopic guidance (Fig. 1b). He was seen by his respiratory physician for medical optimization prior to elective resection performed 10 days after stent deployment without the use of a stoma. Histopathology of the resected specimen (Fig. 1c) demonstrated a low-grade adenocarcinoma, T3b N1b. He made a smooth recovery and has since commenced adjuvant chemotherapy. In colonic cancer, surgical morbidity and mortality are substantially higher for emergent surgery than for elective cases [1]. In the case described, preoperative
ª 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Colonic stenting in malignant large bowel obstruction
decompression of the obstructing tumor by deployment of a stent allowed for appropriate optimization of his medical status as well as standard bowel preparation prior to surgery with minimal delay. This resulted in him undergoing a semi-elective, one-stage resection without stoma construction, minimizing delay in the institution of subsequent adjuvant chemotherapy.
Conflict of Interest None declared. Reference 1. Leitman, I. M., J. D. Sullivan, D. Brams, and J. J. DeCosse. 1992. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg. Gynecol. Obstet. 174:513.
617
