Usefulness of surgical closure following intraoperative endoscopic additional stenting of duodenal perforation by stent: Report of a case.
BACKGROUND
Malignant duodenal stenosis occurs in patients with advanced periampullary cancer. Insertion of a self-expanding metal stent for the treatment of this condition carries the risk of subsequent perforation of the duodenum. We report successful treatment of duodenal perforation induced by a stent.


METHODS
An 80-year-old woman suffering from stenosis caused by advanced periampullary cancer underwent metallic stent placement and her symptoms improved. While attempting biliary re-stenting to prevent restenosis after 4 months, the proximal end of the duodenal metallic stent migrated into the abdominal cavity. Using a laparotomy intraoperative endoscope, duodenal stents were placed into the prolapsed stent in the form of stent-in-stent to reduce the axial force of the stent, after which the puncture site was closed by suturing. No leakage or stenosis was observed at the duodenum, and the patient was able to eat normally until her death 4 months after surgery.


CONCLUSIONS
Surgical closure following intraoperative endoscopic additional stenting is a viable option for duodenal perforation caused by a stent.
Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan.
Kenji
K
Shimizu
Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan. Electronic address: takamori60b@gmail.com.
Hiroshi
H
Takamori
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Hideo
H
Baba
Duodenal stent; Intraoperative stenting; Perforation