Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report

Natthawut Phothong; Jirawat Swangsri; Thawatchai Akaraviputh; Vitoon Chinswangwatanakul; Atthaphorn Trakarnsanga

doi:10.1016/j.ijscr.2016.07.012

Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report

Int J Surg Case Rep. 2016:26:38-41. doi: 10.1016/j.ijscr.2016.07.012. Epub 2016 Jul 14.

Authors

Natthawut Phothong¹, Jirawat Swangsri², Thawatchai Akaraviputh², Vitoon Chinswangwatanakul², Atthaphorn Trakarnsanga³

Affiliations

¹ Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand; Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Pak Kret, Nonthaburi, 11120, Thailand.
² Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.
³ Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand. Electronic address: atthaphorn.tra@mahidol.ac.th.

Abstract

Introduction: Pneumatosis intestinalis is one of serious conditions following mechanical bowel obstruction. Emergency surgery is generally required to be a definite treatment in these patients of pneumatosis intestinalis, because of its risk of bowel ischemia and perforation. Since the operation in unprepared colon usually resulted in unfavorable outcome, the use of colonic stent is considered one of potential options as a bridge to definitive surgery. Presently, there is no widely published report of using colonic stent in these patients, particularly for stepping to curative surgery. Therefore, we herein report a case of obstructing sigmoid cancer with pneumatosis intestinalis who underwent successfully emergency metallic stent placement to convert from emergency to elective surgery.

Presentation of case: A 50-year-old woman presented with 3-day history of abdominal pain and obstipation. Abdominal computed tomography demonstrated a short segment of circumferential luminal narrowing at sigmoid colon, the presence of pneumatosis intestinalis at cecum, including ascending colon, and no extraluminal air. We performed colonoscopy and placed the metallic stent. The patient was then improved. After 1 week, the patient underwent elective hand-assisted laparoscopic sigmoidectomy and was discharged 5days later. Pathological report showed stage IIa sigmoid cancer. The patient had no local recurrence or distant metastasis in 1year follow up.

Conclusion: In obstructing colonic patient with pneumatosis intestinalis, nonsurgical treatment by colonic stenting can be used in selected patient as a bridge to definitive surgery. This will result in decreased morbidity and mortality and lower rate of stoma formation.

Keywords: Bridge to surgery; Case report; Colonic obstruction; Pneumatosis intestinalis; Sigmoid cancer; Stenting.