LATE CLOSED LOOP OBSTRUCTION OF THE SIGMOID AFTER LEFT URETERAL ENDOMETRIOSIS RESECTION: MINIMALLY INVASIVE RESOLUTION WITH COLONOSCOPIC STENT PLACEMENT FOLLOWED BY LAPAROSCOPIC SIGMOIDECTOMY

Case Presentation A 35-year-old female physician, previously undergoing partial resection of the left ureter and end-to-end anastomosis, along with partial resection of the mesosigmoid for deep endometriosis, developed a localized abscess in the sigmoid. This was treated clinically with systemic antibiotics. Six months later, while on vacation, she experienced abdominal pain, distention, and cessation of flatulence and feces. She went to the emergency room where she was diagnosed with a closed loop obstruction in the sigmoid and was advised to undergo an emergency colostomy. The patient opted to return to her city. A colonoscopy revealed a complete and short 4 cm sigmoid obstruction, and a 9 cm colon stent was placed. The effect was immediate, with immediate evacuations and an improvement in the colon distension confirmed by imaging. A slow bowel preparation was carried out over 2 days with Movinlax, which was effective, resulting in liquid evacuations, and surgery was indicated.

Surgical Procedure Laparoscopy was performed with the placement of five trocars: one 11 mm in the epigastric region, one 12 mm in the right iliac fossa, and three 5 mm in the left iliac fossa and flanks. A blockage of the small intestine in the left iliac fossa was identified and relieved, with the stent found in the cavity. The left paracolic gutter was freed from the retroperitoneum. The proximal rectum at the level of the promontory was prepared, stapled with a linear stapler, and the sigmoid vessels were ligated, extending from the colon to the region above the stent. The specimen was exteriorized via a 5 cm Pfannenstiel incision, and the 29 mm Echelon® circular stapler was placed. An intra-corporeal end-to-end anastomosis was performed, with a negative leak test, and the cavity was drained.

Postoperative Course The patient showed excellent recovery, with evacuations from the first day and oral diet introduction. She was discharged on the 5th day after drain removal. Thirty days post-surgery, the patient was asymptomatic, with normal, daily evacuations.

Discussion The self-expanding metallic endoscopic stent represents a minimally invasive and effective alternative for relieving intestinal obstruction. Initially proposed for colorectal malignant tumors in the 1990s, it is now used as a bridge to surgery to avoid emergency stoma creation, as demonstrated in this case.

Conclusion The decision to use a stent as a bridge to minimally invasive surgery without a colostomy proved to be a safe and effective measure for resolving a severe problem with high complication potential.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
25. April 2025