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Clin Case Rep. 2016 June; 4(6): 616–617.
Published online 2016 May 10. doi:  10.1002/ccr3.560
PMCID: PMC4891492

Colonic stenting in malignant large bowel obstruction

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

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.

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. (Fig.1a).1a). At urgent colonoscopy, successful decompression of the bowel was achieved using a metallic stent (WallFlex Colonic 90 mm × 25 mm) placed across the malignant stricture into the proximal colon under fluoroscopic guidance (Fig. (Fig.1b).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. (Fig.1c)1c) demonstrated a low‐grade adenocarcinoma, T3b N1b. He made a smooth recovery and has since commenced adjuvant chemotherapy.

Figure 1
(A) Computed tomography (CT) of the abdomen and pelvis. (B) Colonic stenting under fluoroscopic guidance. (C) Macroscopic view of resected descending colon.

In colonic cancer, surgical morbidity and mortality are substantially higher for emergent surgery than for elective cases 1. In the case described, preoperative 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., Sullivan J. D., Brams D., and DeCosse J. J.. 1992. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg. Gynecol. Obstet. 174:513. [PubMed]

Articles from Clinical Case Reports are provided here courtesy of Wiley-Blackwell