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DOI: 10.1055/a-2713-1484
The Interesting Case

When surgery and endoscopic decompressive gastrostomy are not an option: CT-guided transhepatic decompression for malignant bowel obstruction in a patient after esophagectomy with colon interposition.

Wenn Chirurgie und endoskopische dekompressive Gastrostomie keine Option sind: CT-gesteuerte transhepatische Dekompression bei malignem Darmverschluss bei einem Patienten nach Ösophagektomie mit Koloninterponat

Authors

  • Ahmed Alwali 

    1   Department of General, Visceral, Thoracic, Vascular and Transplant Surgery, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)

  • Kristina Bath

    2   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)

  • Marc-André Weber 

    2   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)

  • Clemens Schafmayer

    1   Department of General, Visceral, Thoracic, Vascular and Transplant Surgery, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)

  • Imad Kamaleddine 

    1   Department of General, Visceral, Thoracic, Vascular and Transplant Surgery, Rostock University Medical Center, Rostock, Germany (Ringgold ID: RIN39071)
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Introduction

A malignant bowel obstruction is a challenging complication in advanced gastrointestinal cancers. It can result from the compression by tumor, diffuse carcinomatosis, or adhesions from prior surgeries. Regardless of the underlying cause, malignant bowel obstructions and their associated symptoms are highly distressing and severely impact the quality of life for patients. For those with inoperable tumors and malignant bowel obstruction, decompressive gastrostomy is considered an effective method to relieve symptoms. This procedure can be performed either surgically or percutaneously with endoscopic or fluoroscopic guidance. However, these approaches may be challenging or unfeasible in patients with altered anatomy following surgery or extensive peritoneal carcinomatosis and thus need an interdisciplinary approach. This report details the case of a patient with peritoneal metastasis after an esophagectomy with colon interposition, who presented with recurrent vomiting due to malignant bowel obstruction and a “frozen abdomen”, and underwent transhepatic decompression of the colon interposition under CT and endoscopic guidance.



Publication History

Received: 31 January 2025

Accepted after revision: 26 September 2025

Article published online:
10 October 2025

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