“Intestinal stent” – relief of malignant obstruction

   ”Intestinal stenting” is a treatment technique that has been applied only in recent years but has been widely used. It is a treatment method of placing a metal mesh stent in the narrowed part of the intestine to relieve obstruction, so that the obstructed part of the intestine can be reopened and the patient can be relieved of pain. The following is a case of a patient with liver metastasis of rectal cancer and malignant obstruction of the colon who underwent intestinal stent implantation in our department.  The patient was a 69-year-old female, diagnosed as “adenocarcinoma of rectum” on colonoscopy in July 2014 due to frequent and unformed stools, and further enhanced abdominal CT showed “thickening of the wall of the upper rectum near the junction with the sigmoid colon, with local protrusion into the lumen, rough mucosal surface and surrounding The patient was diagnosed and treated with standardized chemotherapy and other symptomatic treatment by oncology department.  In November 2014, the patient showed signs of “abdominal distension and stool obstruction”. On 2014-12-10, the patient underwent “rectal angiography + stent implantation” after consultation by the Department of Vascular Surgery 2, and the operation was successfully completed. The patient was discharged from the hospital after several days of symptom relief.  Image description (a): The above is the patient’s preoperative abdominal CT: the intestinal canal at the junction of rectum and colon is obviously narrowed, and the passage of intestinal contents is obstructed; the intestinal canal above the stenosis is obviously dilated, and there is a large amount of intestinal contents and gas accumulation in the intestinal canal.  Image caption (2): The above patient’s abdominal CT was reviewed 6 months after surgery: the obstructed section of the intestinal canal between the rectum and the colon was propped up by the stent, the intestinal canal was restored, and the intestinal contents passed smoothly through the stent into the rectum, and the intestinal stent in the patient’s body was in good shape six months after surgery, and no obvious displacement was seen.       Photo caption (c): The above is the patient’s 12-month postoperative follow-up review abdominal CT: 1 year after surgery, the patient’s intestinal stent is in good shape, the lumen is open, the intestinal contents are partially restricted through the stent, a small amount of soft tissue infiltration can be seen in the stent, and the contents of the colon have increased, but the patient’s current medical history shows that the patient relieves stool 5-9 times a day, the stool is yellow and formed, and there is no abdominal distension and discomfort.  Experience summary: Currently, intestinal stents are most commonly used in the treatment of malignant obstruction of the duodenum, colon and rectum, which is also a palliative treatment or temporary transitional treatment. Its purpose is to temporarily or permanently relieve intestinal obstruction in order to restore intestinal patency.  It is an immediate and effective, minimally invasive procedure that is less invasive and can provide a good solution to the patient’s pain and improve his or her quality of life. Moreover, intestinal stents are now mostly made of titanium-nickel alloy, which has good biocompatibility, corrosion resistance and elasticity, and can produce a gentle expansion force to restore the narrow intestine to patency. The good elasticity of the stent can make it deform with the normal intestinal peristalsis and reduce the irritation and discomfort of the intestinal wall.  As a means in tumor treatment mileage, it is very worthy to be promoted and applied.