Duodenal stent obstruction - duodenal adenocarcinoma

Case contributed by Dr. Thiago P. Fernandes

Presentation

Known history of duodenum adenocarcinoma under palliative treatment with a duodenal stent, presenting with new onset of post-prandial vomiting. The stent was placed 2 months prior to actual symptoms.

Patient Data

Age: 85 years
Gender: Female
CT

CT Abdomen and pelvis

Non-contrast enhanced CT in axial and coronal views raises suspicion for apparent endoprosthesis obstruction at the level of the 2nd portion of the duodenum; it might be due to a combination of extrinsic compression and tumor/soft tissue growth. The finding is better appreciated, and unequivocal, on the sagittal plane.

Distension of the GI tract before the stenosis point and food residue is seen, resulting in repeated vomiting.

X-ray

Abdominal radiograph

Imaging findings and stenosis point were confirmed by an upper GI endoscopy, and a new stent was placed. Post-procedure abdominal radiography with adequate stent positioning is shown.

Case Discussion

Duodenal prosthesis/stents are useful in palliative situations, either when there is an unacceptable surgical risk or the patient chooses a non-surgical approach. They are considered a safe alternative; a review article from 2004 claims that have been no deaths related to the procedure 1

Besides being a less invasive procedure, they are also more cost-effective than the traditional palliative gastrojejunostomy, in many cases 2.

Complications of the stent procedure are considered, in general, rare. Nevertheless, there have been reported cases of perforation, migration, bleeding, ulceration, food impaction, and obstruction 1.

Additionally, another study has reported two cases of recurrent vomiting after stent placement; one of those happened eight weeks after placement and was caused by acute and chronic inflammatory growth of soft tissue (biopsy proved); whilst the other was due to stent malpositioning. Similar to this case, both cases were adequately treated with additional stent placement 3.

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Case information

rID: 66340
Published: 11th Mar 2019
Last edited: 11th Mar 2019
Inclusion in quiz mode: Excluded
Institution: A. C. Camargo Cancer Center

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