Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case
| Autor: | B. Pilsgaard, Søren Meisner, Filip K. Knop, Peer Wille-Jørgensen |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Decompression medicine.medical_treatment Perforation (oil well) Ischemia Endoscopy Gastrointestinal Emergency surgery Medicine Cecal Diseases Humans Adverse effect Aged medicine.diagnostic_test business.industry Gastroenterology Stent General Medicine equipment and supplies medicine.disease Decompression Surgical Colorectal surgery Surgery Endoscopy Intestines Intestinal Perforation Female Stents Radiology business Colorectal Neoplasms Intestinal Obstruction |
| Zdroj: | Diseases of the colon and rectum. 47(11) |
| ISSN: | 0012-3706 |
| Popis: | Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink