Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Inserting Two Self-expandable Metal Stents in Dual Malignant Colonic Obstructions

동시성 대장암에 의한 이중 장폐쇄의 단계적 자가팽창형 금속스텐트 삽입 치료 1예

  • Kim, Ju-Wan (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Choi, Chang-Hwan (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Park, Ji-Hoon (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Cha, Bong-Ki (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kim, Ki-Seong (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Jung, Seung-Mun (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Do, Jae-Hyuk (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Chang, Se-Kyung (Department of Internal Medicine, Chung-Ang University College of Medicine)
  • 김주완 (중앙대학교 의과대학 내과학교실) ;
  • 최창환 (중앙대학교 의과대학 내과학교실) ;
  • 박지훈 (중앙대학교 의과대학 내과학교실) ;
  • 차봉기 (중앙대학교 의과대학 내과학교실) ;
  • 김기성 (중앙대학교 의과대학 내과학교실) ;
  • 정승문 (중앙대학교 의과대학 내과학교실) ;
  • 도재혁 (중앙대학교 의과대학 내과학교실) ;
  • 장세경 (중앙대학교 의과대학 내과학교실)
  • Published : 2011.03.30
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Abstract

Malignant colonic obstruction can lead an emergency operation for decompression, and this can cause post-operative complications due to poor bowel preparation. Self-expandable metal stent (SEMS) insertion is useful for avoiding an emergency operation and unnecessary complications. However, SEMS insertion for dual malignant colonic obstructions is very rare. We report here on a case of two SEMS that were inserted in dual malignant colonic obstructions caused by synchronous colon cancer. A 66-year-old man visited our hospital due to abdominal distension. Sigmoidoscopy and an abdominopelvic computerized tomographic (CT) scan revealed synchronous colon cancer at the splenic flexure and distal descending colon with dual obstruction. The initial SEMS insertion on the descending colon was not effective for decompression due to the proximal obstruction. After the second SEMS insertion on the splenic flexure through the first stent, all the signs and symptoms due to obstruction disappeared. SEMS insertion is considered to be useful for treating dual malignant colonic obstruction caused synchronous colon cancer.

장폐쇄를 동반한 대장암에서 응급 수술은 불량한 장정결 및 전신 상태로 합병증 발생 가능성이 높으며, 경우에 따라서는 회장루 형성이 불가피하다. 자가팽창형 금속스텐트 삽입은 이러한 환자에서 응급 수술을 피하고 계획된 수술을 가능하게 하며, 또한 근치 수술을 시행하지 못하는 환자에서도 증상 완화 목적으로 사용된다. 저자들은 두 부위에 장폐쇄를 유발한 동시성 대장암 환자에서 두 단계에 걸친 자가팽창형 금속스텐트 삽입술로 성공적으로 장폐쇄를 치료하여 보고한다. 66세 남자가 복부팽만감으로 내원하여 장폐쇄를 동반한, 하행결장 원위부 및 비장만곡부의 동시성 대장암을 진단받았다. 급성 장폐쇄를 해결하기 위해 대장내시경을 통해 하행결장 원위부에 자가팽창형 금속스텐트를 삽입하였으나 증상 호전 없어, 비장만곡부에 스텐트를 추가 삽입하였고, 이후 성공적으로 감압이 유도되었다. 동시성 대장암에 의한 이중 장폐쇄의 경우에도 자가팽창형 금속스텐트 삽입술은 매우 유용할 것으로 생각한다.

Keywords

References

  1. Brealier RS. Colorectal cancer. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management. volume 2. 9th ed. Philadelphia: Saunders, 2010: 2191-2238.
  2. Chang YS, Lee KY, Lee SH, Yoon C. Usefulness of a self-expandable metallic stent for a malignant colorectal obstruction. J Korean Soc Coloproctol 2005;21:300-306.
  3. Lee KY, Kim NK, Park JS, Park JK, Lee YC, Min JS. Stent insertion as a bridge to one stage operation in malignant obstruction of left colon (6 cases). J Korean Surg Soc 2001;60:667-670.
  4. Kim BW, Lee KJ, Kim JH, Suh KW. Temporary indwelling of self-expandable metal stent may obviate the need of staged operation for malignant colonic obstruction. J Korean Soc Coloproctol 2001;17:91-96.
  5. Evers BM, Mullins RJ, Mathewes TH, Broghamer WL, Polk HC Jr. Multiple adenocarcinomas of the colon and rectum. An analysis of incidences and current trends. Dis Colon Rectum 1988;31:518-522. https://doi.org/10.1007/BF02553724
  6. Nikoloudis N, Saliangas K, Economou A, et al. Synchronous colorectal cancer. Tech Coloproctol 2004;8(suppl 1):177S-179S. https://doi.org/10.1007/s10151-004-0149-2
  7. Takeuchi H, Toda T, Nagasaki S, et al. Synchronous multiple colorectal adenocarcinomas. J Surg Oncol 1997;64:304-307. https://doi.org/10.1002/(SICI)1096-9098(199704)64:4<304::AID-JSO10>3.0.CO;2-2
  8. Leitman IM, Sullivan JD, Brams D, DeCosse JJ. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 1992;174:513-518.
  9. Scott NA, Jeacock J, Kingstone RD. Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 1995;82:321-323. https://doi.org/10.1002/bjs.1800820311
  10. Tomiki Y, Watanabe T, Ishibiki Y, et al. Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction. Surg Endosc 2004;18:1572-1577. https://doi.org/10.1007/s00464-004-8106-8
  11. Dohmoto M. New method-endoscopic implanatation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig 1991;3:1507-1512.
  12. Kim HH, Kim HK, Cho SH, et al. Usefulness of self-expandable metallic stents for malignant colon obstruction. J Korean Soc Coloproctol 2009;25:113-116. https://doi.org/10.3393/jksc.2009.25.2.113
  13. Keymling M. Colorectal stenting. Endoscopy 2003;35:234-238. https://doi.org/10.1055/s-2003-37265
  14. Smith AS, Cole M, Vega KJ, Munoz JC. Palliation of malignant rectal obstruction from invasive prostate cancer with multiple overlapping self-expanding metal stents. South Med J 2009;102:1257-1259. https://doi.org/10.1097/SMJ.0b013e3181bf69a4
  15. Song, GA, Kang DH, Kim TO, et al. Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents. Gastrointest Endosc 2007;65:782-787. https://doi.org/10.1016/j.gie.2006.08.030
  16. Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096-1102. https://doi.org/10.1046/j.1365-2168.2002.02148.x
  17. Elsberger B, Rourke K, Brush J, Glancy S, Collie M. Self-expanding metallic stent insertion in the proximal colon. Colorectal Dis 2008;10:194-196.
  18. Jung MK, Park SY, Jeon SW, et al. Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction. Surg Endosc 2010;24:525-530. https://doi.org/10.1007/s00464-009-0604-2