Delayed perforation of colonic stent for malignant large bowel obstruction

Case contributed by Chris O'Donnell


Inoperable sigmoid colonic cancer. Stent inserted. Now very severe abdominal pain and bloating.

Patient Data

Age: 80
Gender: Male

Metallic stent in the sigmoid colon.  The proximal end sits within the mural thickening (presumed to represent tumor) and its flared end has eroded through the wall anteriorly producing surrounding soft tissue swelling and free gas bubbles.  This is best seen on the sagittal projection. 

Note the right hepatic lobe mass indicative of metastasis.

Case Discussion

Malignant large bowel obstruction is a serious medical condition.  In patients who are unfit for surgery or who have established metastatic disease, colonoscopic stenting is used to overcome the obstruction albeit with the potential for mural rupture and/or leak at the time of insertion or subsequently due to stent migration and mechanical erosion (as in this case by the flared end of the stent)

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