RESUMEN
Malignancies of gastro-intestinal tract cause stricture formation that leads to intestinal obstruction. In such cases, either surgery or placement of self-expanding metallic stents (SEMS) are options of palliation. For left sided colorectal obstruction, SEMS have been widely used and reported. Luminal stenting is not always an easy task to perform because of altered anatomy of the surrounding structures, specially in the right side of colon and terminal ileum. SEMS placement, particularly in the ileocecal region, is technically difficult. Few studies on SEMS deployment in right sided colon have been reported till now. We report a case of metastatic signet ring cell carcinoma of rectosigmoid junction with malignant terminal ileal stricture palliation done with placement of SEMS.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/cirugía , Implantación de Prótesis/métodos , Stents Metálicos Autoexpandibles , Adulto , Colonoscopía/métodos , Femenino , Humanos , Enfermedades del Íleon/diagnóstico , Obstrucción Intestinal/diagnóstico , Diseño de Prótesis , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the safety of trans-nasal percutaneous endoscopic gastrostomy (TPEG) placement for nutrition in patients where oral approach is not possible. STUDY DESIGN: Case-series. PLACE AND DURATION OF STUDY: April 2010 to April 2016 in the Department of Gastroenterology at Liaquat National Hospital, Karachi. METHODOLOGY: Patients underwent trans-nasal PEG placement and were included in this study. Inclusion criteria were either gender of any age and patients referred for PEG tube placement in whom oral PEG tube insertion was not possible. Ultrathin gastroscope (outer diameter of 5.9 mm) was passed through a nostril after assessment and lubrication, the pull technique was used for tube placement. Primary outcome variable of study was the safety of the procedure. The secondary outcome variables were procedure related complications during and 72 hours after the procedure. RESULTS: TPEG placement was successful in all 46 cases. Thirty-one (67.4%) were males. The mean age was 56.63 ±12.62 years. Dysphagia was the main indication in all cases. Head and neck cancer was the most common indication present in 38 (82.6%) patients. In 36 (78.2%) cases, the procedure was performed under local anesthesia. PEG site infection occurred in one (2.1%) patient. CONCLUSION: TPEG is a safe procedure in patients with oro-pharyngeal obstruction, and it should be considered as an alternative approach.