EP272 - Complications of Self-Expanding Metal Stents in Benign Colonic Obstruction: A Case Report of Complications Due to Stent Migration

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Purpose/Background: Over the last decade, several randomized controlled trials and systematic reviews have been published on colonic stenting for malignant colonic obstruction. The role of self-expandable metal stents (SEMSs) in the treatment of malignant colonic obstruction is to provide a bridge to surgery, allowing for optimization of patients prior to surgical intervention or simply for palliation. Stents have also been employed for benign colonic strictures; however, the evidence in this area is sparse and inconclusive. While stenting in a benign setting may be effective in the short or medium term, it rarely provides a long-term solution. Long-term stent complications include chronic infection, bleeding, frank perforation, and migration. In this case report, we highlight a rare case of acute on chronic anemia, chronic infection, and stent migration secondary to SEMS placement for a sigmoid stricture after colostomy takedown.

Methods/Interventions: An 82-year-old female with a history of colon resection for diverticulitis requiring a colectomy with end colostomy underwent subsequent colostomy takedown. The colostomy takedown was complicated by an anastomotic stricture. She underwent a self-expanding metal stent placement for symptomatic management in an effort to avoid surgery. The patient developed degenerative joint disease of the left hip requiring left total hip arthroplasty. Concomitantly, her stent migrated into the rectum causing symptoms of tenesmus, rectal bleeding, fatigue, and fever. The resulting chronic infection and profound iron deficiency anemia necessitated the definite management of the stent prior to orthopedic intervention.

Results/Outcomes: The patient underwent an open low anterior resection, with creation of end colostomy and ureterolysis. The operative field had a dramatic degree of fibrosis from the impacted and migrated stent. Pathology demonstrated severe fibrosis and foreign body reaction with an imbedded and impacted stent. The patient recovered and was able to be scheduled for her orthopedic surgery six months later.

Conclusion/Discussion: Currently, colonic stents are used as a palliative procedure or as a bridge to surgery in the setting of malignant disease. The long-term efficacy of stents is not well-studied in benign disease. Most patients will experience complications when the stents are left in long term. However, when left in place for only 30 days, complications were noted in 3.4% of patients. The median recommended length of colonic stent duration is 21 days. In this case, the stent migrated and eroded into the rectum, leading to chronic anemia and chronic pelvic infection. Given the hematologic and infectious implications of the stent in the setting of impending joint replacement, she required definitive removal and permanent diversion. This case underscores the risks associated with long-term stent placement, particularly in benign conditions, and highlights the need for clear guidelines on managing colonic stents in such scenarios.