Gupta Sameer, Kacker Luv K
Surgical Oncology, CSMMU, Lucknow, Uttar Pradesh, India.
BMJ Case Rep. 2012 Sep 25;2012:bcr2012006882. doi: 10.1136/bcr-2012-006882.
Self-expandable metallic stents (SEMS) are currently the most widely used modality for palliation of dysphagia from oesophageal malignancy. However, placement of SEMS is associated with a number of complications. We report a rare late complication of SEMS placed for relief of malignant dysphagia (Locally advanced Carcinoma mid-esophagus) in a 65-year-old man. SEMS was expelled out intact with vomiting following complete response to disease after three cycles of chemotherapy. Check on endoscopy done the day after, patient's growth had shown partial response to chemotherapy with scope easily negotiable upto Gastroesophageal junction with area of scarring and healed ulceration and stent imprint on the oesophageal wall. Partial response of the disease to chemotherapy and lack of expected fibrosis between stent and oesophageal wall resulted in loss of scaffolding for the stent and its subsequent expulsion in vomiting and relief in patient's dysphagia.
自膨式金属支架(SEMS)是目前缓解食管恶性肿瘤所致吞咽困难应用最广泛的方式。然而,SEMS置入会引发多种并发症。我们报告了一例罕见的迟发性并发症,该并发症发生在一名65岁男性身上,其因缓解恶性吞咽困难(食管中段局部晚期癌)而置入SEMS。在接受三个周期化疗后疾病完全缓解,随后患者呕吐时SEMS完整排出。次日进行的内镜检查显示,患者的肿瘤对化疗有部分反应,内镜可轻松通过至胃食管交界处,此处有瘢痕形成、溃疡愈合以及食管壁上的支架印记。疾病对化疗的部分反应以及支架与食管壁之间缺乏预期的纤维化,导致支架失去支撑结构,随后在呕吐时排出,患者吞咽困难得到缓解。