2021 Volume 41 Issue 4 Pages 273-276
An 86-year-old man was diagnosed as having advanced gastric cancer and referred to our hospital. Endoscopy revealed type 3 gastric cancer with cardiac stenosis and extension toward the esophagus. A covered self-expanding type metallic stent was inserted taking into consideration his advanced age and reduced ADL. About 3 months after the stenting, he was diagnosed as having cholecystitis and referred to our hospital again. A plain abdominal radiograph and abdominal computed tomography（CT）showed that the stent had fractured into two pieces; the proximal fragment was not displaced and lay in the lower esophagus, while the distal fragment had migrated to the duodenum and caused cholecystitis. The distal fragment was removed by a two-step approach; we moved it to the stomach from the duodenum using a fiberoptic endoscope, and then performed gastrotomy to remove it from the stomach. Endoscopic stent placement is one of the palliative treatments for unresectable malignant gastrointestinal tract stenosis. Although this procedure is minimally invasive and can improve the patient’s quality of life to a similar degree as palliative operation, care must be taken to avoid fatal complications. We report an extremely rare case of a spontaneously fractured esophageal stent, which is the first such recorded instance in Japan.
