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Abstract：
BACKGROUND: Endoscopic esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although stent placement is safe and effective method, complications are increasing the morbidity and mortality rate. We aimed to present a patient with small bowel perforation as a consequence of migrated esophageal stent.
METHODS: A 77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis.
CONCLUSIONS: Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis.
CONCLUSIONS: Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration.
METHODS: A 77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis.
CONCLUSIONS: Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis.
CONCLUSIONS: Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration.
摘要：
背景：内镜食管支架置入术用于治疗良性狭窄，食管穿孔,瘘管和食管癌的姑息治疗。虽然支架置入是安全有效的方法,并发症的发病率和死亡率都在增加。我们的目的是介绍一名因食管支架迁移而导致小肠穿孔的患者。
方法：一名77岁女性因腹痛而入院，腹胀,呕吐了两天。她过去的病史包括11年前胰腺肿瘤的胰十二指肠切除术，6个月前远端食管癌部分切除术和2个月前食管吻合口狭窄支架置入术。腹部检查,有广义压痛伴回弹。计算机断层扫描显示支架已迁移。剖腹手术显示，由于食管支架的迁移，回肠有穿孔。切除肠穿孔部分约5cm，进行吻合。由于败血症，患者在手术后55天出院。
结论：小肠穿孔是食管支架移位的一种罕见但严重的并发症。食管胃交界处的切除促进了支架的迁移。支架的内腔通常允许在肠道中通过，因此，在早期找出错位以避免不希望的结果是很麻烦的。在我们的案例中,食管胃交界处的切除促进了支架的迁移，症状的迟发延迟了诊断。
结论：患有食管支架的患者必须经常随访以避免延迟并发症。需要额外的技术程序来防止支架移动。
方法：一名77岁女性因腹痛而入院，腹胀,呕吐了两天。她过去的病史包括11年前胰腺肿瘤的胰十二指肠切除术，6个月前远端食管癌部分切除术和2个月前食管吻合口狭窄支架置入术。腹部检查,有广义压痛伴回弹。计算机断层扫描显示支架已迁移。剖腹手术显示，由于食管支架的迁移，回肠有穿孔。切除肠穿孔部分约5cm，进行吻合。由于败血症，患者在手术后55天出院。
结论：小肠穿孔是食管支架移位的一种罕见但严重的并发症。食管胃交界处的切除促进了支架的迁移。支架的内腔通常允许在肠道中通过，因此，在早期找出错位以避免不希望的结果是很麻烦的。在我们的案例中,食管胃交界处的切除促进了支架的迁移，症状的迟发延迟了诊断。
结论：患有食管支架的患者必须经常随访以避免延迟并发症。需要额外的技术程序来防止支架移动。
