Stenting of benign oesophageal strictures is feasible, but we are unclear as to the
potential for complications in the long term, especially following distal stent migration.
We report a fatal complication which occurred many years after placement that argues
for the retrieval of all dislodged stents.
A 91-year-old gentleman presented to hospital with clinical evidence of life-threatening
small bowel obstruction. He had had an Atkinson tube inserted 8 years previously to
treat a recurring distal oesophageal stricture. (At that time, due to coexisting cardiopulmonary
compromise, he was deemed unfit for surgical intervention.) The stent had migrated
to the stomach within the first year of placement. As subsequent attempts at endoscopic
removal failed, a policy of “watchful waiting” was adopted.
On admission, supine radiography of his abdomen demonstrated ileal obstruction secondary
to migration of his oesophageal stent with impaction at the ileocaecal valve (Figure
[1]). The stent, which had become obstructed by a food bolus, was removed under regional
anaesthesia. The patient succumbed to respiratory complications 5 days later.
Figure 1Supine abdominal radiograph demonstrating mechanical ileus secondary to an oesophageal
stent in the distal ileum
In patients who are unfit for surgery, benign oesophageal strictures are managed with
proton pump inhibitors and oesophageal dilation. Should these measures fail, oesophageal
intubation is a potential option [1]
[2]
. Distal stent migration frequently occurs however, and attempts to retrieve the prosthesis
endoscopically often fail [1]
[3]
. This case demonstrates that a stent can pass distally via a normal gastrointestinal
tract into the small bowel with fatal consequences. It is reasonable to conclude that
oesophageal stents that migrate to the stomach should be retrieved electively to avoid
such a complication, and that due consideration be given to operative retrieval via
gastrotomy if endoscopic measures fail.
