499 - Delayed perforation after stent placement for sigmoid colon cancer obstruction

Case Summary

Colonic perforation after stent placement is generally occurs in early phases, within 72 hours, whereas delayed perforations, which we define a perforation over 72 hours after stent placement, have been rarely described. A 76-year-old man, who had undergone stent placement for sigmoid colon obstruction 30 days before and discussed to undergo surgery at the outpatient care, presented sudden lower abdominal pain. He was diagnosed a lower gastrointestinal perforation and we planned to perform emergent surgery. In the operation, we recognized a large amount of stool odor ascites and a perforation from the sigmoid colon. We performed Hartmann procedure. At the gross findings of a specimen, the perforation was the junction areas between normal bowel wall and the tumor. He was discharged uneventfully at postoperative 29 day. Delayed colonic perforation after stent placement may be caused by the weakening of junction areas between normal bowel wall and the tumor or by tumor perforation due to mechanical tumor necrosis arising from stent and wire problems. Our case was the former. Delayed perforation is rare, but we cautiously take care of it long-term after stent placement

Editorial acknowledgement

Clinical trial identification