Emergency Self- Expanding Metal Stenting for Malignant Colonic Obstruction: An Opportunity for Operation in a More Favorable Condition

Abstract

An 86-year-old male patient was admitted to the emergency department with complaints of vomiting, flatulence, abdominal discomfort, and an inability to defecate for at least a week. The patient seemed toxic and unwell with tachycardia and hypotension. He had a remote history of intracranial tumor at the age of 66 years, and it was under control thereafter. Abdominal distension with severe discomfort was observed in physical examination. An emergency chest X-ray showed an enlarged cardiothoracic index, significant ectasia in the aorta, interstitial parenchymal changes, and left-sided pleural effusion (Figure 1a). A plain abdominal X-ray showed multiple air-fluid levels and bowel distension (Figure 1b). Laboratory tests showed the following: leucocyte level 13.6×10 3 /μL (normal value: 3.8-10×10 3 /μL), hemoglobin level 15 g/dL (normal value: 13-17.5 g/dL), platelet count 43 ABSTRACT Introduction: Lower gastrointestinal system tumors represent a major source of morbidity and mortality. Bowel obstruction is a common complication in advanced colorectal cancer. Case Report: An 86-year-old male patient who was admitted to the emergency department with clinical complaints of ileus showed multiple air-fluid levels in an abdominal X-ray film. Computed tomography scans revealed an obstructing malignant mass in the sigmoid colon region. For immediate relief of obstruction, a self-expanding metal stent was placed by colonoscopy. Recovery from abdominal discomfort, flatulence, and vomiting was achieved shortly after stenting. With appropriate treatment and preoperative investigations, the patient was referred to undergo elective colectomy. Conclusion:In elderly and critically ill patients, endoscopic stenting may be an effective treatment for malignant large bowel obstruction. It may also be used as a bridge to surgery in more favorable conditions.