A case report on the use of self-expanding metallic stents in the treatment of stoma obstruction caused by advanced colonic cancer

Lee Lee Lai; Gwo Fuang Ho; Kin Fah Chin

Volume : VII, Issue : I, January - 2018

A case report on the use of self-expanding metallic stents in the treatment of stoma obstruction caused by advanced colonic cancer

Lee Lee Lai, Gwo Fuang Ho, Kin Fah Chin

Abstract :

Patients with advanced colorectal cancer often require palliative care for symptom relief. Bowel obstruction is one of the complications that commonly occur in patients with peritoneal carcinomatosis secondary to advanced colorectal carcinoma. A self–expandable metallic stent (SEMS) has been used widely to relieve large bowel obstruction due to obstructive colon carcinoma. A 51–years–old lady underwent a laparoscopic ultra–low anterior resection for rectal carcinoma with a covering loop ileostomy for a Stage III rectal carcinoma. Having declined an adjuvant chemotherapy, the patient developed recurrent disease 2 years after surgery. She complained of severe abdominal pain associated with abdominal distension and non–productive ileostomy. Computed tomography (CT scan) showed that the patient developed a complete stoma obstruction due to peritoneal carcinomatosis. Endoscopy through ileostomy revealed malignant small bowel obstruction due to a cluster of peritoneal tumours just beyond the abdominal wall. The self–expanded metal stent (SEMS) was inserted at the stomal orifice due to her poor clinical condition, which precluded a laparotomy. Following the self–expandable metallic stent, complete relief of patient’s pain and bowel obstruction due to advanced colon carcinoma. Self–expandable metal stent insertion through a stoma could become an alternative treatment option for patients with advanced abdominal carcinoma who otherwise may have to tolerate a poor quality of life with complete bowel obstruction towards the end of their lives.