Endoscopic placement of self-expanding metal stent for malignant colorectal obstruction

AIM: 15-20% of the patients with colorectal carcinoma is admitted to hospital with symptoms of colonic obstruction. If urgent, subtotal colectomy can not be done, Hartmann operation is performed, that means diverting colostomy and resection followed by a later re-anastomosis. In this article the authors report on the placement of a self-expandable stent for decompression of a malignant colorectal obstruction, which allows elective one stage resection of the tumour affected segment. PATIENTS AND METHODS: A 63-year-old male patient was admitted with clinical and radiological symptoms of ileus. A total obstruction was found by irrigoscopy at the rectosigmoid transition. An atraumatic guide wire, and a balloon catheter were introduced through the stenotic segment and dilated to 15-mm in diameter. Following that the stenosis was bridged with a SX Ella type, 25-mm diameter, nitiol stent. RESULTS: After the placement of the metal stent the obstruction ceased. Stabilisation of the condition of the patient, proper pre-operative decompression, definition of the tumour stage, appropriate preparation of the patient for the operation became possible. After elective, primary resection the patient recovered without complications. DISCUSSION: There are two main indications for the application of metal stents in colorectal obstructions. One of them is temporary, preoperative decompression in malignant colorectal obstruction. The other one is the palliative treatment of inoperable, malignant large bowel obstructions. In the latter case more complications have to be considered. CONCLUSIONS: Metal stent therapy is an effective and non-invasive, alternative method for preoperative or palliative treatment of malignant colorectal obstructions.