Emergency colonic stenting for acute malignant obstruction

This video shows the case of a 56-year-old man with a T2N2M1 sigmoid cancer managed under radiochemotherapy referred for bowel obstruction without gas and without faeces for four days, with a dilated abdomen. An abdominal CT-scan confirmed the colonic obstruction caused by an obstructing lesion at the rectosigmoid junction, 18cm away from the anal verge. An endoscopic colonic stenting is demonstrated.

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Emergency colonic stenting for acute malignant obstruction

Authors

Gf Donatelli, S Perretta, B Dallemagne

Abstract

This video shows the case of a 56-year-old man with a T2N2M1 sigmoid cancer managed under radiochemotherapy referred for bowel obstruction without gas and without faeces for four days, with a dilated abdomen. An abdominal CT-scan confirmed the colonic obstruction caused by an obstructing lesion at the rectosigmoid junction, 18cm away from the anal verge. An endoscopic colonic stenting is demonstrated.

Keywords

Emergency, colonic stenting, acute malignant obstruction

Media type

Surgical video

Duration

03'00''

Publication

2011-09

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E-publication

WeBSurg.com, Sept 2011;11(09).
URL: http://www.websurg.com/doi-vd01en3379.htm

Emergency colonic stenting for acute malignant obstruction

1. Clinical case presentation 00'20''

A 56-year-old man with a T2N2M1 sigmoid cancer managed under radiochemotherapy was referred to our unit for bowel obstruction without gas and without faeces for four days, with a dilated abdomen. An abdominal CT-scan confirmed the colonic obstruction caused by an obstructing lesion at the rectosigmoid junction, 18cm away from the anal verge.

2. Rectosigmoidoscopy and lesion visualization 00'41''

Under general anesthesia with the patient in supine position, a rectosigmoidoscopy was carried out and an ulcerated occluded lesion was found at about 20cm away from the anus.

3. Contrast confirmation of occlusion 00'52''

The injection of medium contrast did not show any passage.

4. Guide wire insertion 00'56''

However, a small orifice was visible and a double-channel cannula preloaded with a 450cm guide wire was inserted in the wall without forcing or pushing. The injection of contrast through the cannula in the wall allowed to visualize a small passage, and the guide wire was advanced across the lesion. The cannula was also advanced, and some contrast was injected. Under fluoroscopy, the folds of the colon wall were visible, hence confirming the intraluminal position. The cannula was slowly withdrawn and contrast was injected under continuous fluoroscopy to measure the length of the mass. In order to select the appropriate stent size, the colon loop was also measured in order to avoid angulation or bending.

5. Wall stent deploying 01'38''

In this case, a 9cm long, 25mm diameter WallFlex™ metal stent (Boston Scientific®) was chosen. The cannula was removed and the Self-Expandable Metal Stent (SEMS) was introduced on the guidewire and passed through the mass. It was then delivered under endoscopic and fluoroscopic control. A nice opening of the stenosis was immediately observed but not large enough to allow for passage through the scope. Adequate passage of liquid faeces was observed. The patient did not experience further trouble with faeces all night long, and the abdomen was completely soft and normal after 10 hours. The patient was discharged the day after and was referred to the oncology department to undergo radiochemotherapy.