Quinn Morgan, Luke David
Department of General Surgery, Heartlands Hospital, Birmingham, UK
Department of General Surgery, Heartlands Hospital, Birmingham, UK.
J Surg Case Rep. 2013 Feb 18;2013(2):rjt004. doi: 10.1093/jscr/rjt004.
We report the case of an elderly female patient with a history of a previous Billroth I gastrectomy who presented with small bowel obstruction secondary to a migrated oesophageal stent. This patient had an iatrogenic oesophageal perforation following therapeutic endoscopy for a benign stricture 4 months prior to presentation. This was treated endoscopically with a covered stent that was not removed as planned. The stent migrated distally lodging in the terminal ileum, causing small bowel obstruction. Oesophageal stent migration is a rare but well-recognized complication of stent placement. Endoscopic stenting is an effective treatment for oesophageal perforation with lower morbidity and mortality than operative repair. Clinicians should be aware that although patients with a history of previous gastric surgery are at no greater risk of stent migration than others, the altered anatomy can affect the final resting place of the migrated stent and hence the clinical effects and sequalae.
我们报告了一例老年女性患者，她有既往毕罗一世胃切除术史，因迁移的食管支架继发小肠梗阻前来就诊。该患者在就诊前4个月因良性狭窄接受治疗性内镜检查后发生医源性食管穿孔。当时通过内镜用覆膜支架进行了治疗，但支架未按计划取出。支架向远端迁移，嵌顿在回肠末端，导致小肠梗阻。食管支架迁移是支架置入罕见但已得到充分认识的并发症。内镜下支架置入术是治疗食管穿孔的有效方法，其发病率和死亡率低于手术修复。临床医生应意识到，虽然既往有胃手术史的患者发生支架迁移的风险并不比其他人更高，但解剖结构的改变会影响迁移支架的最终停留位置，从而影响临床效果和后遗症。
