SS  Vol.2 No.8 , October 2011
Management of Recurrent Large Bowel Obstruction Due to Stent Occlusion by ‘Stent-Over-Stent’: A Case Report and Literature Review
Abstract: Endoscopic stenting for malignant large bowel obstruction is common nowadays. However, recurrent obstruction secondary to stent occlusion due to tumour ingrowth or overgrowth might occur. We reported a case of a 70-year-old man with large bowel obstruction initially treated with colonic stenting. It was complicated with recurrent intestinal obstruction, with colonoscopy showing stent blockage by tumour ingrowth over distal part of the stent. Successful endoscopic implantation of additional colonic stent over the old stent was achieved and intestinal obstruction was resolved afterwards.
Cite this paper: nullD. Tsang, H. Cheung, C. Chung and M. Li, "Management of Recurrent Large Bowel Obstruction Due to Stent Occlusion by ‘Stent-Over-Stent’: A Case Report and Literature Review," Surgical Science, Vol. 2 No. 8, 2011, pp. 418-421. doi: 10.4236/ss.2011.28091.

[1]   U. P. Khot, A. W. Lang, K. Murali and M. C. Parker, “Systematic Review of the Efficacy and Safety of Colorectal Stents,” British Journal of Surgery, Vol. 89, No. 9, 2002, pp. 1096-1102. doi:10.1046/j.1365-2168.2002.02148.x

[2]   R. Bhardwaj and M. C. Parker, “Palliative Therapy of Colorectal Carcinoma: Stent or Surgery?” Colorectal Disease, Vol. 5, No. 5, 2003, pp. 518-521. doi:10.1046/j.1463-1318.2003.00519.x

[3]   S. Biondo, D. Pares and R. Frago, “Large Bowel Obstruction: Predictive Factors for Postoperative Mortality,” Diseases of the Colon and Rectum, Vol. 47, No. 11, 2004, pp. 1889-1897. doi:10.1007/s10350-004-0688-7

[4]   S. Hennekinne-Mucci, J. J. Tuesch and O. Brehant, “Emergency Subtotal/Total Colectomy in the Management of Obstructed Left Colon Carcinoma,” International Journal of Colorectal Disease, Vol. 21, No. 6, 2006, pp. 538-541. doi:10.1007/s00384-005-0048-7

[5]   A. Karadag, B. B. Mentes and A. Uner, “Impact of Stomatherapy on Quality of Life in Patients with Permanent Colostomies or Ileostomies,” International Journal of Colorectal Disease, Vol. 18, No. 3, 2003, pp. 234-238.

[6]   J. P. Im, S. G. Kim, H. W. Kang, J. S. Kim, H. C. Jung and I. S. Song, “Clinical Outcomes and Patency of Self-Expanding Metal Stents in Patients with Malignant Colorectal Obstruction: A Prospective Single Center Study,” International Journal of Colorectal Diseases, Vol. 23, No. 8, 2008, pp. 789-794. doi:10.1007/s00384-008-0477-1

[7]   F. Meyer, F. Marusch and A. Coch, “Emergency Operation in Carcinomas of the Left Colon: Value of Hartmann’s Procedure,” Technology of Coloproctology, Vol. 8, Supplement 1, 2004, pp. S226-S229. doi:10.1007/s10151-004-0164-3

[8]   L. Zorcolo, L. Covotta and N. Carlomango, “Safety of Primary Anastomosis in Emergency Colo-rectal Surgery,” Colorectal Disease, Vol. 5, No. 3, 2003, pp. 262-269. doi:10.1046/j.1463-1318.2003.00432.x

[9]   M. Dohmoto, “New Method—Endoscopic Implantation of Rectal Stent in Palliative Treatment of Malignant Stenosis,” Endoscopia Digestiva, Vol. 3, 1991, pp. 1507-1512.

[10]   J. P. Suh, S. W. Kim, Y. K. Cho, J. M. Park, I. S. Lee, M. G. Choi, et al., “Effectiveness of Stent Placement for Palliative Treatment in Malignant Colorectal Obstruction and Predictive Factors for Stent Occlusion,” Surgical Endoscopy, Vol. 24, No. 2, 2010, pp. 400-406. doi:10.1007/s00464-009-0589-x

[11]   M. A. Vitale, G. Villotti, L. d’Alba, S. Frontespezi, F. Iacopini and G. Iacopini, “Preoperative Colonoscopy after Self-Expandable Metallic Stent Placement in Patients with Acute Neoplastic Colon Obstruction,” Gastrointestinal Endoscopy, Vol. 63, No. 6, 2006, pp. 814-819. doi:10.1016/j.gie.2005.12.032

[12]   H. S. Tilney, R. E. Lovegrove, S. Purkayastha, P. S. Sains, G.. K. Weston-Petrides, A. W. Darzi, et al., “Comparison of Colonic Stenting and Open Surgery for Malignant Large Bowel Obstruction,” Surgical Endoscopy, Vol. 21, No. 2, 2007, 225-233. doi:10.1007/s00464-005-0644-1

[13]   H. Ptok, F. Meyer, F. Marusch, R. Steinert, I. Gastinger, H. Lippert, et al., “Palliative Stent Implantation in the Treatment of Malignant Colorectal Obstruction,” Surgical Endoscopy, Vol. 20, No. 6, 2006, pp. 909-914. doi:10.1007/s00464-005-0594-7

[14]   A. M. Watt, I. G. Faragher, T. T. Griffin, N. A. Rieger and G. J. Maddern, “Self-Expanding Metallic Stents for Relieving Malignant Colorectal Obstruction—A Systemic Review,” Annals of Surgery, Vol. 246, No. 1, 2007, pp. 24-30. doi:10.1097/01.sla.0000261124.72687.72

[15]   J. C. H. Wong, H. Y. S. Cheung, K. K. Yau, C. C. Chung and M. K. W. Li, “Outcomes of Endoluminal Stenting for Distal Colorectal Cancer: An Institutional Experience,” Surgical Practice, Vol. 13, No. 1, 2009, pp. 8-11. doi:10.1111/j.1744-1633.2008.00428.x

[16]   Y. S. Cheung, C. C. Chung, W. W. Tsang, J. C. Wong, K. K. Yau and M. K. Li, “Endo-Laparoscopic Approach Versus Conventional Open Surgery in the Management of Obstructing Left-Sided Colonic Carcinoma: A Randomized Trial,” Archives of Surgery, Vol. 144, No.12, 2009, pp. 1127-1132. doi:10.1001/archsurg.2009.216

[17]   R. Dharmadhikari and C. Nice, “Complications of Colonic Stenting: A Pictorial Review,” Abdominal Imaging, Vol. 33, No. 3, 2008, pp. 278-284. doi:10.1007/s00261-007-9240-2

[18]   D. Tsurumaru, H. Hidaka, S. Okada, T. Sakoguchi, H. Matsuda, T. Matsumata, et al., “Self-Expandable Metallic stents as Palliative Treatment for Malignant Colorectal Obstruction,” Abdominal Imaging, Vol. 32, No. 5, 2007, pp. 619-623. doi:10.1007/s00261-006-9159-z

[19]   F. Branger, E. Thibaudeau, S. Mucci-Hennekinne, E. Metivier-Cesbron, K. Vychnevskaia, A. Hamy, et al., “Management of Acute Malignant Large-Bowel Obstruction with Self-Expanding Metal Stent,” International Journal of Colorectal Disease, Vol. 25, No. 12, 2010, pp. 1481-1485. doi:10.1007/s00384-010-1003-9

[20]   C. S. Shim, J. Y. Cho, I. S. Jung, C. B. Ryu, S. J. Hong, J. O. Kim, et al., “Through-The-Scope Double Colonic Stenting in the Management of Inoperable Proximal Malignant Colonic Obstruction: A Pilot Study,” Endoscopy, Vol. 36, No. 5, 2004, pp. 426-431. doi:10.1055/s-2004-814332

[21]   K. M. Lee, S. J. Shin, J. C. Hwang, J. Y. Cheong, B. M. Yoo, K. J. Lee, et al., “Comparison of Uncovered Stent with Covered Stent for Treatment of Malignant Colorectal Obstruction,” Gastrointestinal Endoscopy, Vol. 66, No. 5, 2007, 931-936. doi:10.1016/j.gie.2007.02.064

[22]   D. Xinopoulos, D. Dimitroulopoulos, K. Tsamakidis, N. Apostolikas and E. Paraskevas, “Treatment of Malignant Colonic Obstructions with Metal Stents and Laser,” Hepatogastroenterology, Vol. 49, No. 44, 2002, pp. 359-362.