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

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...

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Autores principales: Phothong, Natthawut, Swangsri, Jirawat, Akaraviputh, Thawatchai, Chinswangwatanakul, Vitoon, Trakarnsanga, Atthaphorn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957606/
https://www.ncbi.nlm.nih.gov/pubmed/27448227
http://dx.doi.org/10.1016/j.ijscr.2016.07.012
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author Phothong, Natthawut
Swangsri, Jirawat
Akaraviputh, Thawatchai
Chinswangwatanakul, Vitoon
Trakarnsanga, Atthaphorn
author_facet Phothong, Natthawut
Swangsri, Jirawat
Akaraviputh, Thawatchai
Chinswangwatanakul, Vitoon
Trakarnsanga, Atthaphorn
author_sort Phothong, Natthawut
collection PubMed
description 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 5 days later. Pathological report showed stage IIa sigmoid cancer. The patient had no local recurrence or distant metastasis in 1 year 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.
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spelling pubmed-49576062016-08-02 Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report Phothong, Natthawut Swangsri, Jirawat Akaraviputh, Thawatchai Chinswangwatanakul, Vitoon Trakarnsanga, Atthaphorn Int J Surg Case Rep Case Report 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 5 days later. Pathological report showed stage IIa sigmoid cancer. The patient had no local recurrence or distant metastasis in 1 year 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. Elsevier 2016-07-14 /pmc/articles/PMC4957606/ /pubmed/27448227 http://dx.doi.org/10.1016/j.ijscr.2016.07.012 Text en © 2016 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Phothong, Natthawut
Swangsri, Jirawat
Akaraviputh, Thawatchai
Chinswangwatanakul, Vitoon
Trakarnsanga, Atthaphorn
Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title_full Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title_fullStr Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title_full_unstemmed Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title_short Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report
title_sort colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957606/
https://www.ncbi.nlm.nih.gov/pubmed/27448227
http://dx.doi.org/10.1016/j.ijscr.2016.07.012
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