Dillon Jacquelyn, Mills Alexandra N, Pawloski Kate R, Scribetta Nicholas, Greenstein Alexander
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Surg Case Rep. 2023 Jan 10;2023(1):rjac615. doi: 10.1093/jscr/rjac615. eCollection 2023 Jan.
Self-expandable metal stent (SEMS) are widely utilized as a bridge to surgical intervention and for palliative treatment of malignant bowel obstructions. The risk of complications associated with SEMS is low in well-selected patients. Stent erosion is a rare but serious adverse event that is associated with high morbidity and mortality. Here, we report the case of a 74-year-old patient with a colonic obstruction secondary to a pelvic mass that was treated with SEMS and radiotherapy, who developed a partial thickness stent erosion and recurrent hematochezia 6 years after placement. Endoscopic retrieval was not technically feasible. During attempted surgical resection, massive hemorrhage occurred from a colonic-arterial fistula to the left external iliac artery resulting in death. While SEMS remain an effective, minimally invasive approach for the management of bowel obstructions, prolonged lifetime may confer an increased risk of serious adverse events including erosion and fistula formation.
自膨式金属支架（SEMS）被广泛用作手术干预的桥梁以及恶性肠梗阻的姑息治疗手段。在精心挑选的患者中，与SEMS相关的并发症风险较低。支架侵蚀是一种罕见但严重的不良事件，与高发病率和死亡率相关。在此，我们报告一例74岁因盆腔肿块继发结肠梗阻的患者，该患者接受了SEMS和放射治疗，在支架置入6年后发生了部分厚度的支架侵蚀和反复便血。内镜取出在技术上不可行。在尝试手术切除期间，结肠动脉与左髂外动脉形成瘘管导致大量出血，最终患者死亡。虽然SEMS仍然是治疗肠梗阻的一种有效、微创方法，但支架长期留存可能会增加包括侵蚀和瘘管形成在内的严重不良事件的风险。
