Timely deployment of endoscopic colonic stent for relieving acute colonic obstruction.
A 54 year old male patient was diagnosed to have cancer of recto-sigmoid region in October 2017. He underwent investigation for staging of the disease and as planned, he was thought to be a good candidate for surgical management.
In early November, the patient presented to Aster Hospital’s ER with sudden onset of severe constipation, abdominal bloating and vomiting. He was found to have an acute colonic obstruction and was very sick at the time. He was admitted to the hospital and medical treatment was started.
He was referred to GE services for considering endoscopic intervention to help relieve the obstruction to the colon. Sigmoidoscopy was done and a self-expanding metal stent was deployed across the obstructing tumor. This relieved the obstruction and patient regained his normal bowel function rapidly, thus avoiding an emergency surgery. Ten days later the patient was operated upon and the tumor was removed successfully through laparoscopic surgery in a single operation.
Emergency surgery in situations of acute colonic obstruction is associated with increased morbidity and mortality. Complications include infection and post-surgical leaks. Quite often two to three surgical procedures need to be done.
Endoscopic stenting has a vital role in these situations. It allows colonic function to resume, thus allowing upstream bowel to regain optimal dimension and tone. It also allows the surgeon to prepare the colon optimally before surgery. This translates into a much lower complications rates, increased rates of complete and clean surgical resection and abrogates the need for multiple operations.
Decompressing the bowel before surgery has the potential benefit of using minimally invasive modalities like laparoscopy. The above patient underwent Laparoscopic Anterior Resection for recto sigmoid growth and was discharged on 4th post-op day without any post-operative complications.
Self-expanding metal stents (SEMS) have found multiple applications in endoscopic practice. SEMS used in endoscopy practice are much like stents used by cardiologists for PTCA, though much larger in dimensions.
These stents can be placed either under fluoroscopy guidance or through the endoscope, and allow patency of lumen of GIT for prolonged periods of time. In certain situations these stents are inserted to palliate cancerous obstructions and are meant to be retained for a long time, while in some situations like in this particular case, these are meant to be inserted for a short duration and assist in optimizing the patient for a major surgery.
These stents are most commonly used to treat malignant obstructions and once deployed, are not removable, though modern covered stents can be used in benign disease also and can be removed at a subsequent date.
These stents have found application in sealing perforations in GIT as well as controlling massive GI bleed by producing tamponade, and are an essential part of the arsenal of a therapeutic endoscopist.
Specialist General Surgeon