title: Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case.
abstract: Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.
authors.affiliation: Department of Gastrointestinal Surgery K, H:S Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. filipknop@dadlnet.dk
authors.forename: Filip K
authors.initials: FK
authors.lastname: Knop
authors.forename: Bo
authors.initials: B
authors.lastname: Pilsgaard
authors.forename: Søren
authors.initials: S
authors.lastname: Meisner
authors.forename: Peer
authors.initials: P
authors.lastname: Wille-Jørgensen
mesh_terms: D000368:Aged; D002429:Cecal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D019299:Decompression, Surgical; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery*; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000150:complications / Q000175:diagnosis; D015607:Stents