Long-term release of a malignant ileal obstruction by placement of a colorectal self-expandable metal stent.

Abstract

An 84-year-old man underwent the Hartmann procedure with an R1 resection for advanced rectal cancer. One year after surgery, the patient presented with abdominal pain and vomiting. Abdominal radiography and computed tomography revealed an expanding small bowel and ileal obstruction caused by invasion of local, recurrent rectal cancer. In order to release the ileal obstruction, a colorectal self-expandable metal stent was placed via a through-the-scope technique using a colonoscope inserted through a stoma in the transverse colon. After stent placement, the patient's clinical symptoms and signs improved and the symptoms of obstruction did not recur. No major complications associated with the placement of the stent were observed during the 7-month follow-up period. Thus, self-expandable metal stents are a safe and effective palliative treatment for malignant gastroduodenal or colorectal obstructions, and as a bridge to surgery. However, endoscopic placement of these stents in cases of malignant small bowel obstruction is not yet feasible because of the limitations of endoscopic access and the stent delivery system. To our knowledge, this is the first report of malignant ileal obstruction treated with a colorectal self-expandable metal stent using a colonoscope. This case indicates that colorectal self-expandable metal stents can be effectively and safely used to treat malignant ileal obstructions.