RESUMEN
The application of covered metallic stents in the treatment of benign strictures and perforations is still in the early stages, because their removal is difficult and may cause tissue proliferation. The therapeutic effect and the efficiency of a new method for the extraction of a removable metallic stent were examined in three patients treated for oesophageal perforation. Two of the three patients were dilated with a balloon catheter because of corrosive oesophageal stenosis, and the oesophagus was perforated. In one patient mediastinal drainage, and jejunostomy and in the other primary suturing and drainage were performed. Sepsis and mediastinitis developed due to the oesophageal perforation and the fistula caused by the mediastinal drain in the first patient, and the insufficiency of the suture in the second patient. The oesophageal defects were sealed on day 8 and 10 after the perforation, and surgery by a covered stent. In the third patient, the oesophageal rupture caused by the dilatation and the attempt to stent a malignant obstruction was sealed with a covered stent within 2 hours. Parenteral nutrition and broad-spectrum antibiotic therapy were started. Three days after the interventions, swallowing tests with water-soluble contrast medium (Gastrografin) did not reveal any extravasations. Feeding via a nasogastric tube, and later oral feeding was started. After transient mediastinal drainage, the stents were removed on day 35 and 74 after implantation. Both openings healed completely. Restenoses above the stents were dilated again. The rupture of the malignant oesophagus in the third patient, following early, permanent stenting, healed without drainage and with no complications. Even with mediastinitis and concomitant sepsis, large oesophageal perforations can be treated successfully with removable, covered metallic stents and adequate mediastinal drainage.
Asunto(s)
Cateterismo , Drenaje , Perforación del Esófago/terapia , Mediastinitis/terapia , Stents , Anciano , Deglución , Neoplasias Esofágicas/complicaciones , Perforación del Esófago/diagnóstico por imagen , Perforación del Esófago/etiología , Perforación del Esófago/fisiopatología , Estenosis Esofágica/etiología , Estenosis Esofágica/terapia , Femenino , Humanos , Masculino , Mediastinitis/diagnóstico por imagen , Mediastinitis/fisiopatología , Persona de Mediana Edad , RadiografíaRESUMEN
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.