Laparoscopic colectomy after self‐expanding metallic stent placement through the ileocecal valve for right‐sided malignant colonic obstruction: A case report

Takeyama, Hiroshi; Danno, Katsuki; Kogita, Yuya; Nishigaki, Takahiko; Yamashita, Masafumi; Yamazaki, Masami; Yamakita, Tsuyoshi; Nishihara, Akihiro; Hoshi, Minako; Taniguchi, Hirokazu; Mizutani, Masayo; Nakamichi, Itsuko; Yura, Mamoru; Ikeda, Kimimasa; Kurokawa, Eiji

doi:10.1111/ases.12445

Cited by 5 publications

(1 citation statement)

References 10 publications

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“…However, recent studies have concluded that preoperative decompression using SEMS and transanal drainage tube is helpful when performing subsequent elective laparoscopic surgery and one-stage anastomosis [8]. Preoperative decompression of the distended bowel increases intraabdominal working space during surgery and reduces bowel edema, leading to greater safety during one-stage anastomosis [1, 9].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report

et al. 2019

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BackgroundApproximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there is a lack of published studies reporting robot-assisted laparoscopic surgery (RALS) after self-expanding metallic stent (SEMS) placement for malignant rectal obstruction (MRO). To our knowledge, this is the first report to do so.Case presentationAn 80-year-old man with incomplete paralysis of the lower limbs as well as bladder–rectal disorder due to a spine fracture sustained in a fall accident 26 years ago presented with lower abdominal pain and vomiting. Abdominal multi-detector computed tomography revealed an obstructive rectal tumor with distended bowel on the oral side. Emergency colonoscopy was performed, and an SEMS placed. The patency of SEMS and decompression of the distended bowel was confirmed, and elective RALS was performed 29 days after SEMS placement. To our knowledge, this is the first report of RALS after decompression with SEMS placement for MRO.ConclusionsRALS after SEMS placement is a safe and feasible therapeutic strategy for MRO.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report

et al. 2019

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Right-sided malignant colonic obstruction the use of a self expanding metal stent to facilitate laparoscopic surgery: A case report

Sardiwalla

Kumar

et al. 2018

International Journal of Surgery Open

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The use of self expanding metals stents (SEMS) is established for management of left sided colonic obstruction. Its use for right sided malignant colonic obstructing (RMCO) tumours is less established with risks related to perforation of the colon. The use of a right sided colonic stent can be used to decompress the colon or small bowel and facilitate subsequent laparoscopic resection. A 68 year old gentleman presented with a history of right upper quadrant pain associated with fever, chills, loss of weight and abdominal distention. Examination revealed a tender right upper quadrant mass, workup revealed an empyema of the gallbladder with an associated colonic mass. The sepsis was controlled via percutaneous transhepatic cholecystomy and subsequent colonscopy revealed an obstructing hepatic flexure colonic tumour and multiple large left sided colonic polyps not amenable to snare excision. This tumour was stented at endoscopy under fluoroscopic control. The patient was taken to theatre and a laparoscopic subtotal colectomy with complete mesocolic excision and en bloc cholecystectomy was performed. In this case report, we demonstrate the use of SEMS for RMCO as a bridge for laparoscopic subtotal colectomy in a patient with right sided colonic cancer. This case also presented a unique challenge with the associated gallbladder empyema due to cystic duct obstruction. The stenting for RMCO and subsequent laparoscopic subtotal-colectomy was performed successfully for this patient, showing promise in the future utility of SEMS placement in RMCO. This report therefore adds to increasing evidence that emphasize the viability of SEMS in RMCO as a bridge to laparoscopic surgery for more proximal obstructions. According to our literature search, this is the third reported case of laparoscopic colectomy following SEMS for RMCO. Highlights:

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Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

Водолеев¹,

Бурдюков²,

Пирогов³

et al. 2020

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Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment. Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment. Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected. Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

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Laparoscopic colectomy after self‐expanding metallic stent placement through the ileocecal valve for right‐sided malignant colonic obstruction: A case report

Cited by 5 publications

References 10 publications

Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report

Robot-assisted laparoscopic surgery after placing a self-expanding metallic stent for malignant rectal obstruction: a case report

Right-sided malignant colonic obstruction the use of a self expanding metal stent to facilitate laparoscopic surgery: A case report

Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

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