title: Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report.
abstract: BACKGROUND
  Pneumatosis intestinalis is one of serious conditions following mechanical bowel obstruction. Emergency surgery is generally required to be a definite treatment in these patients of pneumatosis intestinalis, because of its risk of bowel ischemia and perforation. Since the operation in unprepared colon usually resulted in unfavorable outcome, the use of colonic stent is considered one of potential options as a bridge to definitive surgery. Presently, there is no widely published report of using colonic stent in these patients, particularly for stepping to curative surgery. Therefore, we herein report a case of obstructing sigmoid cancer with pneumatosis intestinalis who underwent successfully emergency metallic stent placement to convert from emergency to elective surgery.
  
  
  METHODS
  A 50-year-old woman presented with 3-day history of abdominal pain and obstipation. Abdominal computed tomography demonstrated a short segment of circumferential luminal narrowing at sigmoid colon, the presence of pneumatosis intestinalis at cecum, including ascending colon, and no extraluminal air. We performed colonoscopy and placed the metallic stent. The patient was then improved. After 1 week, the patient underwent elective hand-assisted laparoscopic sigmoidectomy and was discharged 5days later. Pathological report showed stage IIa sigmoid cancer. The patient had no local recurrence or distant metastasis in 1year follow up.
  
  
  CONCLUSIONS
  In obstructing colonic patient with pneumatosis intestinalis, nonsurgical treatment by colonic stenting can be used in selected patient as a bridge to definitive surgery. This will result in decreased morbidity and mortality and lower rate of stoma formation.
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand; Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Pak Kret, Nonthaburi, 11120, Thailand.
authors.forename: Natthawut
authors.initials: N
authors.lastname: Phothong
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.
authors.forename: Jirawat
authors.initials: J
authors.lastname: Swangsri
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.
authors.forename: Vitoon
authors.initials: V
authors.lastname: Chinswangwatanakul
authors.affiliation: Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand. Electronic address: atthaphorn.tra@mahidol.ac.th.
authors.forename: Atthaphorn
authors.initials: A
authors.lastname: Trakarnsanga
keywords: Bridge to surgery; Case report; Colonic obstruction; Pneumatosis intestinalis; Sigmoid cancer; Stenting