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Intestinal Obstruction Due to Migrated Esophageal Stent: A Case Report |
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Mürsit Dincer, Gamze Citlak, Riza Küpelioglu, Turgay yildiz, Muzaffer Akinci 1. Faculty, Department of Gastrointestinal Surgery, Haseki Training and Research Hospital, Istanbul, Turkey. 2. Faculty, Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey. 3. Faculty, Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey. 4. Faculty, Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey. 5. Faculty, Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey. |
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Correspondence Address : Dr. Mürsit Dincer, Haseki Training and Research Hospital Millet CD Aksaray Fatih, Istanbul, Turkey. E-mail: drmursitdincer@gmail.com |
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| ABSTRACT |  | ||||||||||||||||||
Use of the endoscopic self-expandable metallic stent is a non-surgical technique to recanalizing in patients with malignancy. It is a feasible and effective technique but the risk of stent migration is high. Herein, we report a case of mortalitiy ileal obstruction due to migrated oesophageal stent. | |||||||||||||||||||
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| Keywords : Complication, Dysphagia, Esophagogastric junction cancer | |||||||||||||||||||
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| CASE REPORT | | ||||||||||||||||||
A 53-year old female patient who had covered SEMS for unresectable esophagogastric junction cancer was admitted to the hospital with complaints of abdominal pain and vomiting. The stent was inserted six months ago for cancer due to obstruction. In her physical examination, distension was observed and there were re-bound tenderness in all quadrants of abdomen. Initial blood tests showed haemoglobin of 9.1 g/dL, haematocrit of 23.9%. C-reactive protein was 429 mg/L and the other biochemical tests were normal. X-ray and CT confirmed that she had an intestinal obstruction caused by stent migration (Table/Fig 1),(Table/Fig 2). Surgery was performed and laparotomy revealed an obstruction localised in the ileum due to the migrated oesophageal stent (Table/Fig 3). There was no perforation on the small intestine. A 2 cm (approximately) incision was made and the stent was taken out of the ileum. The incision was closed primarily. Anastomotic leak occured in post-operative day four. Re-laparatomy was performed urgently. Posterior side of the anastomosis was seperated. Double barrel ileostomy on right lower quadrant of the abdomen was done. Unfortunately, the patient died due to sepsis caused by anastomotic leakage. | |||||||||||||||||||
| DISCUSSION | | ||||||||||||||||||
Non surgical palliative techniques are available to recanalize malignant obstruction. Oesophageal stents have been used in patients with malignant dysphagia (1). The endoscopic Self-Expandable Metallic Stent (SEMS) is a good option in patients with unresectable malignancy (2),(3),(4). Stent insertion and consequently, complications has increased in recent years. Complications encountered with the use of oesophageal SEMS insertion comprise perforation, bleeding, stent migration, reflux, chest pain, recurrent dysphagia, and food bolus impaction. The most complications are stent obstruction and migration (5). For SEMS, stent migration occurs at a frequency of 16–25% (2). Chemotherapy may increase the risk of stent migration (6). Using SEMS instead of plastic can prevent the migration of oesophageal stents (7). There is no optimised stent form or a stent placement technique. In general, most stents migrate no further than stomach and remain in the stomach without complications (8). Thus, small bowel obstruction is a rare complication of migrated oesophageal stent. Often surgery may be the only treatment option in a patient with intestinal obstruction due to migrated stent. | |||||||||||||||||||
| CONCLUSION | | ||||||||||||||||||
Use of SEMS for patients with malignant dysphagia has become a feasible alternative to surgery. However, patients should be informed about the complications. Stent migration can be the cause of intestinal obstructions. It is important to remember that stents complications may be life threatening. | |||||||||||||||||||
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