Surgical Treatment of Non-Iatrogenic Complications After Endoscopic Prosthetic Replacement of Distal Severely Stenotic Colorectal Tumors
DOI:
https://doi.org/10.14748/kyzqaz59Keywords:
peritonitis, perforation, endoprosthesis, stenotic colon carcinomasAbstract
Introduction: Colorectal cancer is a pressing issue in modern society and has seen significant growth in recent decades. Endoscopic prosthetics of severely stenotic distal colorectal carcinomas are among the most innovative and highly specialized methods of stent implantation in gastroenterology, indicated for stenotic colon carcinomas for the purpose of bridging to other therapies—chemotherapy/targeted therapy/subsequent surgical intervention—as well as in palliative patients assessed by an oncology committee for palliative and symptomatic care for the purpose of resolving the passage.
Aim: Analysis of institutional experience in the treatment of non-iatrogenic complications arising after usage of endoscopic prosthetics for distal stenosing carcinomas and assessment of surgical behavior has been conducted.
Materials and Methods: A retrospective, two-center observation of 2 clinical cases for the period February 2024–April 2025, based on diagnostic and anamnestic data, imaging and endoscopic examinations, a sample of surgical protocols, and results from postoperative follow-up of patients, reflected in the hospital information system of Acibadem City Clinic Mladost Hospital and Acibadem City Clinic Tokuda University Hospital, has been done.
Results: The observation includes two cases of late complications, manifested in the development of local abscess, perforation, and fecal peritonitis. Both patients had secondary hematogenous dissemination and local peritoneal carcinomatosis, with stenting serving as a bridging to other therapies—chemotherapy/targeted therapy. The intraoperative finding concluded fecal peritonitis as a result of non-iatrogenic perforation of the intestine in the stenting area, caused by the intensive growth of the tumor and the development of local ischemia and necrosis of the pathological segment.
Discussion: In patients with decompensated vital functions and severe comorbidity, a combination of conservative procedures is indicated, including stenting of stenotic tumors, which ensures restoration of passage, improves the general condition of the patient, does not require removal of the stomach, and removes the necessity of urgent surgical intervention, while providing the opportunity for full surgical treatment at a later date.
Conclusion: Properly identifying the alternative solutions for low colon obstruction lowers the risk of complications. However, usage of endoscopic prosthetics combined with growth of the tumor may be the cause for other sever complications, therefor this method is to be applied on case-by-case basis, after assessing the benefits and risks for the patient.
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