Western University of Health Sciences Lancaster, CA, United States
Susan Y. Li, BS1, Brandon T. Nguyen, BS1, Sadie De Silva, MD2, Vivaik Tyagi, MD3, Kumaravel Perumalsamy, MD3, Duminda Suraweera, MD3 1Western University of Health Sciences, Lancaster, CA; 2UHS Southern California Medical Education Consortium, Temecula, CA; 3Gastro Care Institute, Lancaster, CA
Introduction: Management of large bowel obstruction using self-expanding metal stents (SEMS) has historically been primarily used for malignant processes. However recently SEMS have progressively gained acceptance for use in select patients with benign colorectal disorders. Here we provide a review of such cases.
Case Description/Methods: Case 1: A 67-year-old male with history of sigmoid volvulus status post sigmoidectomy and colocolonic anastomosis who presented with abdominal pain. Computed tomography (CT) showed anastomotic stenosis with proximal colonic dilation. Colonoscopy showed non-traversable structuring at anastomosis and a guidewire was placed with subsequent cannulation of the proximal lumen and placement of a 22 mm x 120 mm SEMS with fluoroscopic guidance. Patient did well post-procedure.
Case 2: A 55-year-old female with history of sigmoid resection for complicated diverticulitis with colocolonic anastomosis who presented with abdominal pain. CT showed possible narrowing at anastomotic site. Colonoscopy showed a 3 cm long stricture just above the anastomosis. Under fluoroscopic and endoscopic guidance, a 23 mm x 105 mm covered SEMS was placed. Patient did well post-procedure.
Case 3: A 36-year-old male with history of recurrent sigmoid diverticulitis who presented with persistent abdominal pain, nausea, and diarrhea status post laparoscopic sigmoid colectomy with colorectal anastomosis. CT showed a contained leak at the anastomosis. Flexible sigmoidoscopy was used to bridge the leak using a 23 mm x 155 mm covered SEMS under fluoroscopic guidance. Multiple clips were placed at both ends of the stent to prevent migration. Patient improved post-procedure and was discharged home a few days later.
Case 4: A 70-year-old female with history of sigmoid diverticulitis who presented with intractable nausea, vomiting, and abdominal pain. CT showed focal narrowing of the sigmoid colon with colonic dilatation consistent with obstruction. Flexible sigmoidoscopy showed a 6-7 cm stricture with sharp angulation in the sigmoid colon. A 25 mm x 120 mm uncovered SEMS was placed under fluoroscopy. Patient improved post-procedure and underwent sigmoid colectomy a week later.
Discussion: Colonic stents can be used for the management of benign conditions in select patients, including those with complications of diverticular disease, inflammatory bowel disease, radiation therapy and iatrogenic complications from surgery. Careful patient selection and technical expertise are vital in ensuring favorable outcomes.
Figure: Figure 1a: Fluoroscopy of deployed stent (Case 1) Figure 1b: Endoscopic view of deployed stent (Case 2)
Disclosures: Susan Li indicated no relevant financial relationships. Brandon Nguyen indicated no relevant financial relationships. Sadie De Silva indicated no relevant financial relationships. Vivaik Tyagi indicated no relevant financial relationships. Kumaravel Perumalsamy indicated no relevant financial relationships. Duminda Suraweera indicated no relevant financial relationships.
Susan Y. Li, BS1, Brandon T. Nguyen, BS1, Sadie De Silva, MD2, Vivaik Tyagi, MD3, Kumaravel Perumalsamy, MD3, Duminda Suraweera, MD3. P2316 - Colonic Stent Placement in Nonmalignant Cases, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.