Stenting for Stoma stenosis in an unfit patient: A novel endoscopic technique for unsolved challenge
EAES Academy. Gumber A. 07/05/22; 363022; P066
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Abstract
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Introduction:
Stoma stenosis is an uncommon but challenging complication faced by the surgeon and patient. Lack of blood supply, obesity, emergency surgery and challenges in maturing the stoma leads to stoma stenosis in up to 9% of the patients. Chances of stenosis with colostomy have been reported higher than ileostomy in the medical literature. Due to rarity of this complication, there is paucity in the literature and a lack of evidence for appropriate management. Often, it mandates an early or delayed surgery for refashioning the stoma, which can be difficult in unfit patients. The aim of reporting this case is to present a newer endoscopic technique of stenting the stenosed stoma as another option for treatment.
Methods:
A 61-year-old hypertensive and diabetic gentleman with a BMI of 52 underwent difficult laparoscopic abdominoperineal excision of low rectal tumour following neoadjuvant therapy. The creation of stoma was challenging due to bulky colon and it’s mesertery and the abdominal wall thickness of 118mm at the pre-marked site in the left abdomen. As per the standard approach, end colostomy was spouted by 1cm above the skin. Patient developed stoma necrosis in the immediate post-operative period and subsequently severe stenosis. Re-operation was not possible due to body habitus and co-morbidities. A local revision with multiple radial incisions (Fig. 1) followed by insertion of uncovered self expanding Biodegradable (BD) stent (Fig. 2) next day achieved reasonable dilatation. The stent had a diameter of 31mm and length of 60mm. Top end of the stent was kept at the level of the mucocutaneous junction.
Results:
Challenging major re-operation avoided following a successful novel stenting approach. The stent dissolved in 3 months. Patient continued with dilators subsequently and has a stomal opening of 2.5cm, fifteen months following the surgery. Further intentional weight loss by 15kg over the last six months has helped.
Conclusion:
Stoma stenosis is a rare condition, and the treatment is often demanding. As an additional tool to deal with such complication, BD stenting proved to be rewarding. It has been therapeutic in this case, but it can certainly allow time for a planned revision or closure of the stoma later.
Stoma stenosis is an uncommon but challenging complication faced by the surgeon and patient. Lack of blood supply, obesity, emergency surgery and challenges in maturing the stoma leads to stoma stenosis in up to 9% of the patients. Chances of stenosis with colostomy have been reported higher than ileostomy in the medical literature. Due to rarity of this complication, there is paucity in the literature and a lack of evidence for appropriate management. Often, it mandates an early or delayed surgery for refashioning the stoma, which can be difficult in unfit patients. The aim of reporting this case is to present a newer endoscopic technique of stenting the stenosed stoma as another option for treatment.
Methods:
A 61-year-old hypertensive and diabetic gentleman with a BMI of 52 underwent difficult laparoscopic abdominoperineal excision of low rectal tumour following neoadjuvant therapy. The creation of stoma was challenging due to bulky colon and it’s mesertery and the abdominal wall thickness of 118mm at the pre-marked site in the left abdomen. As per the standard approach, end colostomy was spouted by 1cm above the skin. Patient developed stoma necrosis in the immediate post-operative period and subsequently severe stenosis. Re-operation was not possible due to body habitus and co-morbidities. A local revision with multiple radial incisions (Fig. 1) followed by insertion of uncovered self expanding Biodegradable (BD) stent (Fig. 2) next day achieved reasonable dilatation. The stent had a diameter of 31mm and length of 60mm. Top end of the stent was kept at the level of the mucocutaneous junction.
Results:
Challenging major re-operation avoided following a successful novel stenting approach. The stent dissolved in 3 months. Patient continued with dilators subsequently and has a stomal opening of 2.5cm, fifteen months following the surgery. Further intentional weight loss by 15kg over the last six months has helped.
Conclusion:
Stoma stenosis is a rare condition, and the treatment is often demanding. As an additional tool to deal with such complication, BD stenting proved to be rewarding. It has been therapeutic in this case, but it can certainly allow time for a planned revision or closure of the stoma later.
Introduction:
Stoma stenosis is an uncommon but challenging complication faced by the surgeon and patient. Lack of blood supply, obesity, emergency surgery and challenges in maturing the stoma leads to stoma stenosis in up to 9% of the patients. Chances of stenosis with colostomy have been reported higher than ileostomy in the medical literature. Due to rarity of this complication, there is paucity in the literature and a lack of evidence for appropriate management. Often, it mandates an early or delayed surgery for refashioning the stoma, which can be difficult in unfit patients. The aim of reporting this case is to present a newer endoscopic technique of stenting the stenosed stoma as another option for treatment.
Methods:
A 61-year-old hypertensive and diabetic gentleman with a BMI of 52 underwent difficult laparoscopic abdominoperineal excision of low rectal tumour following neoadjuvant therapy. The creation of stoma was challenging due to bulky colon and it’s mesertery and the abdominal wall thickness of 118mm at the pre-marked site in the left abdomen. As per the standard approach, end colostomy was spouted by 1cm above the skin. Patient developed stoma necrosis in the immediate post-operative period and subsequently severe stenosis. Re-operation was not possible due to body habitus and co-morbidities. A local revision with multiple radial incisions (Fig. 1) followed by insertion of uncovered self expanding Biodegradable (BD) stent (Fig. 2) next day achieved reasonable dilatation. The stent had a diameter of 31mm and length of 60mm. Top end of the stent was kept at the level of the mucocutaneous junction.
Results:
Challenging major re-operation avoided following a successful novel stenting approach. The stent dissolved in 3 months. Patient continued with dilators subsequently and has a stomal opening of 2.5cm, fifteen months following the surgery. Further intentional weight loss by 15kg over the last six months has helped.
Conclusion:
Stoma stenosis is a rare condition, and the treatment is often demanding. As an additional tool to deal with such complication, BD stenting proved to be rewarding. It has been therapeutic in this case, but it can certainly allow time for a planned revision or closure of the stoma later.
Stoma stenosis is an uncommon but challenging complication faced by the surgeon and patient. Lack of blood supply, obesity, emergency surgery and challenges in maturing the stoma leads to stoma stenosis in up to 9% of the patients. Chances of stenosis with colostomy have been reported higher than ileostomy in the medical literature. Due to rarity of this complication, there is paucity in the literature and a lack of evidence for appropriate management. Often, it mandates an early or delayed surgery for refashioning the stoma, which can be difficult in unfit patients. The aim of reporting this case is to present a newer endoscopic technique of stenting the stenosed stoma as another option for treatment.
Methods:
A 61-year-old hypertensive and diabetic gentleman with a BMI of 52 underwent difficult laparoscopic abdominoperineal excision of low rectal tumour following neoadjuvant therapy. The creation of stoma was challenging due to bulky colon and it’s mesertery and the abdominal wall thickness of 118mm at the pre-marked site in the left abdomen. As per the standard approach, end colostomy was spouted by 1cm above the skin. Patient developed stoma necrosis in the immediate post-operative period and subsequently severe stenosis. Re-operation was not possible due to body habitus and co-morbidities. A local revision with multiple radial incisions (Fig. 1) followed by insertion of uncovered self expanding Biodegradable (BD) stent (Fig. 2) next day achieved reasonable dilatation. The stent had a diameter of 31mm and length of 60mm. Top end of the stent was kept at the level of the mucocutaneous junction.
Results:
Challenging major re-operation avoided following a successful novel stenting approach. The stent dissolved in 3 months. Patient continued with dilators subsequently and has a stomal opening of 2.5cm, fifteen months following the surgery. Further intentional weight loss by 15kg over the last six months has helped.
Conclusion:
Stoma stenosis is a rare condition, and the treatment is often demanding. As an additional tool to deal with such complication, BD stenting proved to be rewarding. It has been therapeutic in this case, but it can certainly allow time for a planned revision or closure of the stoma later.
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