1624 Metal Stent Insertion for Malignant Obstruction of a Colostomy

Abstract

INTRODUCTION: Malignant obstruction of a colostomy is a rare occurrence that is traditionally treated with surgical intervention; however, there are no clear recommendations for management when surgery is not feasible. Here we report a case of successful placement of a colonic stent for malignant stomal obstruction due to metastatic cervical cancer. CASE DESCRIPTION/METHODS: A 47-year-old female with a history of metastatic cervical cancer presented with abdominal distention and minimal stool output from her colostomy for 2 weeks duration. She was diagnosed with cervical cancer three years prior. Her disease progressed rapidly despite treatment and was complicated by rectovaginal fistula for which she underwent laparoscopic diverting colostomy. The patient noticed an enlarging mass near the ostomy site which was biopsied and showed metastatic adenocarcinoma of endocervical origin. Examination revealed a benign abdomen with palpable peristomal subcutaneous masses. A CT scan showed a large heterogenous abdominal mass causing compression and obstruction at the level of the colostomy with significant proximal colonic dilation, measuring up to 8 cm. As a temporizing measure a rubber catheter was passed through the stoma for decompression. Given the extensive metastatic disease she was not a candidate for any operative intervention, and subsequently endoscopic stent placement was pursued. Colonoscopy was performed showing a severe stenosis 4 cm in length at the surgical stoma. A 25 mm × 6 cm self-expandable covered metal stent (SEMS) was successfully placed with the distal edge visible externally but not protruding beyond skin level. Her obstructive symptoms resolved shortly after the procedure. Two months later, a CT scan showed a patent stent still in place without recurrent colonic obstruction. DISCUSSION: Stenosis and malignant colostomy obstruction are among the complications of stoma construction. Surgery is usually the traditional treatment of these complications, but data is limited concerning the management of patients that are not good surgical candidates. There are very few case reports describing the use of either covered or uncovered SEMS for colostomy obstruction, all of which remained patent until the patients’ death 1.5 – 6 months later. In conclusion, metal stent insertion for malignant obstruction of colostomy could be a viable palliative treatment option in patients who are not operative candidates.