A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent
- 作者: Filimonov V.B.1, Leonchenko S.V.2, Natalsky A.A.1, Kleymenov O.V.1, Prus S.Y.3, Vinogradova M.P.3, Romashov D.V.3
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隶属关系:
- Ryazan State Medical University
- Regional Clinical Hospital
- City Clinical Emergency Hospital
- 期: 卷 32, 编号 3 (2024)
- 页面: 475-482
- 栏目: Clinical reports
- ##submission.dateSubmitted##: 05.10.2022
- ##submission.dateAccepted##: 16.01.2023
- ##submission.datePublished##: 04.10.2024
- URL: https://journals.eco-vector.com/pavlovj/article/view/111570
- DOI: https://doi.org/10.17816/PAVLOVJ111570
- ID: 111570
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详细
INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction.
The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy.
CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.
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作者简介
Viktor Filimonov
Ryazan State Medical University
Email: Filimonov1974@mail.ru
ORCID iD: 0000-0002-2199-0715
SPIN 代码: 7090-0428
MD, Dr. Sci. (Med.)
俄罗斯联邦, RyazanSergey Leonchenko
Regional Clinical Hospital
Email: leonc17@yandex.ru
ORCID iD: 0000-0002-5266-7486
SPIN 代码: 4713-4490
MD, Cand. Sci. (Med.), Associate Professor
俄罗斯联邦, RyazanAlexander Natalsky
Ryazan State Medical University
Email: lorey1983@mail.ru
ORCID iD: 0000-0002-2387-3440
SPIN 代码: 6503-4327
MD, Dr. Sci. (Med.), Professor
俄罗斯联邦, RyazanOleg Kleymenov
Ryazan State Medical University
编辑信件的主要联系方式.
Email: kleimenov.oleg8@gmail.com
ORCID iD: 0000-0001-6293-8924
SPIN 代码: 5371-7670
俄罗斯联邦, Ryazan
Stanislav Prus
City Clinical Emergency Hospital
Email: stanislavprus@mail.ru
ORCID iD: 0000-0002-8383-7775
SPIN 代码: 5759-9708
MD, Cand. Sci. (Med.)
俄罗斯联邦, RyazanMarina Vinogradova
City Clinical Emergency Hospital
Email: vinogradovamp@gmail.com
ORCID iD: 0000-0003-0175-5723
SPIN 代码: 1583-0473
MD, Cand. Sci. (Med.)
俄罗斯联邦, RyazanDmitry Romashov
City Clinical Emergency Hospital
Email: dmitrijromasov10@gmail.com
ORCID iD: 0000-0002-0819-1249
SPIN 代码: 5425-0252
俄罗斯联邦, Ryazan
参考
- Kaprin AD, Starinskiy VV, Shakhzadova AO. Sostoyaniye onkologicheskoy pomoshchi naseleniyu Rossii v 2021 godu. Moscow; 2022. (In Russ).
- Kazakova SS, Aftaeva EV, Kurkova EA. Cardioesophageal carcinoid: multidisciplinary approach to diagnosis. I. P. Pavlov Russian Medical Biological Herald. 2019;27(4):512–9. (In Russ). doi: 10.23888/PAVLOVJ 2019274512-519
- Esaulenko IE, Petrova TN, Tolbin AA, et al. Optimization of System of Early Detection of Oncological Diseases in Outpatient Medical Organizations. I. P. Pavlov Russian Medical Biological Herald. 2023;31(4): 635–42. (In Russ). doi: 10.17816/PAVLOVJ609568
- Martins B, Sorbello MP, Retes F, et al. Endoscopic removal of migrated esophageal stent — the “grasper and pusher” method. Endoscopy. 2012;44:E10. doi: 10.1055/s-0031-1291496
- Toya Y, Yamada S, Yanai S, et al. Gastrointestinal: Endoscopic removal of a migrating esophageal metallic stent. J Gastroenterol Hepatol. 2021;36(5):1151. doi: 10.1111/jgh.15334
- Rubio Mainardi MS, Alcaraz A, Patricia S, et al. Esophageal metalic stent migration. Case report of a dislodged stent retrieval. Acta Gastroenterol Latinoam. 2015;45(4):320–2.
- Othman HM, Petrov VN. Clinical Case of Diospyrobezoar Complicated with Acute Intestinal Obstruction. Nauka Molodykh (Eruditio Juvenium). 2022;10(4):447–58. (In Russ). doi: 10.23888/HMJ2022104447-458
- Karatepe O, Acet E, Altiok M, et al. Esophageal stent migration can lead to intestinal obstruction. N Am J Med Sci. 2009;1(2):63–5.
- Bay J, Penninga L. Small bowel ileus caused by migration of oesophageal stent. Ugeskr Laeger. 2010;172(33):2234–5.
- Kriger AG, Kazakov IV. Migration of the esophageal stent as a reason of the ileal obstruction. Pirogov Russian Journal of Surgery. 2013;(11): 58–60. (In Russ).
- Ho HSS, Ong HS. A rare life-threatening complication of migrated nitinol self-expanding metallic stent (Ultraflex). Surg Endosc. 2004;18(2): 347. doi: 10.1007/s00464-003-4248-3
- Ortiz–Mendoza CM, Nieves–Valerdi AA. Esophageal metallic-stent migration: a rare cause of anal pain in a patient with gastric cancer. Indian J Surg Oncol. 2018;9(4):576–7. doi: 10.1007/s13193-018-0780-4
- Schumacher C, Decker G, Ries F. Esophageal stent migration leading to distal small bowel perforation. Acta Gastroenterol Belg. 2020;83(4):663–5.
- Markar SR, Ross A, Low DE. Gastric ulceration following oesophageal stent migration complicating surgical management of oesophageal cancer. Interact Cardiovasc Thorac Surg. 2012;15(2):320–2. doi: 10.1093/icvts/ivs211
- Law R, Prabhu A, Fujii–Lau L, et al. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc. 2018;32(2):675–81. doi: 10.1007/s00464-017-5720-9
- Watanabe K, Hikichi T, Nakamura J, et al. Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration. Endosc Int Open. 2017;5(11):E1044–9. doi: 10.1055/s-0043-111793
- Dua KS, De Witt JM, Kessler WR, et al. A phase III, multicenter, prospective, single-blinded, noninferiority, randomized controlled trial on the performance of a novel esophageal stent with an antireflux valve (with video). Gastrointest Endosc. 2019;90(1):64–74.e3. doi: 10.1016/j.gie.2019.01.013