Expandable metal stent application in obstructing carcinoma of the proximal colon: report of a case.
OBJECTIVE
The increased mortality of emergency vs. elective colonic surgery applies equally to the right and left colon. Recent interest has surrounded the application of expandable metal stenting in acute obstruction but has been confined to the left colon. We describe successful application of stenting in the right colon, allowing postponement of a particularly high-risk laparotomy.


METHODS
A patient with acute bilateral iliofemoral thromboses simultaneously developed complete obstruction of the proximal transverse colon. After heparinization and under fluoroscopic control, a 10-cm-long, self-expanding Wall-stent (Schneider, Bulach, Switzerland), 22 mm in diameter, was manipulated across the obstruction.


RESULTS
Immediate decompression with symptomatic relief ensued. The stent prevented obstruction during a 10-week period of anticoagulation, and repeat duplex scanning showed resolution of iliac thrombus. An elective right hemicolectomy was then performed. Postoperative course was uncomplicated, and histopathology confirmed a Dukes B carcinoma.


CONCLUSIONS
This case, in which a potentially hazardous laparotomy was delayed until the operative risk improved, defines a new role for stenting in colonic obstruction and demonstrates an extension of its applicability to the right colon. Literature review found no other report of stent application in the right colon.
Campbell
K L
KL
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill, United Kingdom.
Hussey
J K
JK
Eremin
O
O
D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000150:complications / Q000628:therapy*; D000075202:Contraindications; D017558:Elective Surgical Procedures; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000209:etiology / Q000628:therapy*; D007813:Laparotomy; D008297:Male; D015607:Stents; D013924:Thrombophlebitis / Q000150:complications* / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin