Two Cases of Palliation for Malignant Colorectal Obstruction with Endoscopically Inserted Expandable Metal Stent

Abstract

The use of a metal stent in malignant colorectal obstruction is not well established in Japan. The traditional method of managing inoperable colonic obstruction has been palliative colostomy or insertion of long tube. However, these methods were invasive and/or umcomfortable for patients. We report two cases of malignant rectal obstruction which was treated with expandable metal stent. Case 1 is a 65-year-old female diagnosed to have advanced gastric cancer with Schnitzler metastasis. Barium enema and colonoscopy showed severe stenosis due to extraluminal compression. Case 2 is an 89-year-old female diagnosed to have rectal cancer. They were inoperable and developed abdominal pain due to ileus during hospitalization. EMS with the inner diameter of 18mm (Ultraflex prosthesis) was inserted for their rectal obstruction. Stent expansion brought about immediate decompression of the obstructed bowel. After the treatment, their abdominal symptom were relieved and no complications were developed in both cases. In our opinion, the treatment could maintain patient's QOL until their death compared with traditional method. Stent decompression could be palliative treatment for inoperable malignant colonic obstruction.