Placement of a self-expandable metal stent is a common palliative treatment for malignant
esophageal strictures. Stent migration is a recognized complication, occurring with
a frequency of about 3 % [1], and may occur as an immediate or delayed complication. Stents most commonly migrate
into the stomach but have been reported as impacted in the colon and even passed unrecognized
per rectum [2]. We report a case of distal migration leading to acute intestinal obstruction.
A 61-year-old gentleman presented to the emergency department with a 72-hour history
of vomiting, and abdominal distension and discomfort. His past medical history included
an adenocarcinoma of the lower third of the esophagus diagnosed 2 years previously.
At this time his symptoms were palliated using an ELLA stent (Dr Karel Volenec, Czech
Republic), with the antireflux valve and the position verified with contrast radiology
postprocedure.
Plain abdominal radiography at the time of admission showed the stent to be located
in the patient’s right iliac fossa, with radiographic evidence of small-bowel obstruction
([Figure 1]). The patient was managed initially with placement of a nasogastric tube and intravenous
fluids but failed to improve so was prepared for laparotomy. At surgery there was
dilatation throughout the small bowel, and the stent was palpable in the terminal
ileum, impacting in the ileocecal valve. An enterotomy was performed, the stent removed
and the enterotomy closed.
Figure 1 Self-expandable metal stent migrated to the right iliac fossa causing small-bowel
obstruction.
Distal migration of an esophageal stent beyond the stomach is uncommon and rarely
results in complication [2]. Stent migration usually occurs within weeks of insertion but has been reported
in at least one case at 10 months postinsertion [3]. This case is unusual, as 2 years had passed since the stent was placed. As the
patient died of respiratory failure after surgery, there was no opportunity to assess
esophageal disease progression or symptom recurrence, and no satisfactory explanation
for this extremely delayed complication can be offered.
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