Challenges Associated with Low Rectal Malignant Obstruction Stenting: a Case Report

Division

North Florida

Hospital

Osceola Regional Medical Center

Document Type

Case Report

Publication Date

9-10-2024

Keywords

anal adenocarcinoma, anorectal ring, self-expanding metallic stents

Disciplines

Digestive System Diseases | Medicine and Health Sciences | Neoplasms | Surgery

Abstract

An ongoing debate exists regarding the feasibility of placing self-expanding metallic stents (SEMS) within 5 cm of the anal verge. Traditionally, SEMS have been considered contraindicated for patients with a malignant rectal obstruction within this region due to potential impact on the anorectal ring or anal canal, which can cause incontinence, proctalgia, and tenesmus. However, in the case of a 63-year-old female who presented with distention, abdominal pain, and diminishing stool output, the rectal exam identified a bulky fixed mass. Imaging studies revealed large bowel obstruction and high-grade stricture, with a minuscule residual lumen. Endoscopy identified a bulky mass obscuring the lumen at 5 cm from the anal verge, and biopsy confirmed adenocarcinoma. Despite the traditionally held contraindication, a 2.5 cm × 9.0 cm colonic stent was successfully deployed, leading to brisk colonic decompression. This allowed the patient to promptly undergo chemoradiotherapy.

Publisher or Conference

Journal of Surgical Case Reports

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