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Acute Colorectal Obstruction: Treatment with Self-expandable Metallic Stents before Scheduled Surgery—Results of a Multicenter Study

¹ Radiology Service, Hospital Central del Insalud de Soria, Spain (A.M.)
² Departments of Interventional Radiology (M.A.D.G.A., E.A., J.A.F.)
³ Surgery (E.T.), Hospital Clínico Universitario de Zaragoza, San Juan Bosco 15, 50-009 Zaragoza, Spain
⁴ Interventional Radiology Section, Hospital Uiversitario de Getafe, Madrid, Spain (I.P.)
⁵ Interventional Radiology Section, Clínica La Zarzuela, Madrid, Spain (R.T.)
⁶ Radiology Service, Louisiana State University Medical Center, New Orleans (M.H.).

View larger version (171K): [in a new window]   Figure 1a. Illustrations depict placement of the stent. (a) The guide wire and catheter are advanced through the area of obstruction. (b) The guide wire is replaced by an Amplatz stiff guide wire to straighten the tortuous rectosigmoid region, and the delivery system is introduced. (c) The stent is initially deployed at the proximal portion of the lesion. (d) The stent is fully expanded and symmetric in diameter throughout its length.

View larger version (152K): [in a new window]   Figure 1b. Illustrations depict placement of the stent. (a) The guide wire and catheter are advanced through the area of obstruction. (b) The guide wire is replaced by an Amplatz stiff guide wire to straighten the tortuous rectosigmoid region, and the delivery system is introduced. (c) The stent is initially deployed at the proximal portion of the lesion. (d) The stent is fully expanded and symmetric in diameter throughout its length.

View larger version (147K): [in a new window]   Figure 1c. Illustrations depict placement of the stent. (a) The guide wire and catheter are advanced through the area of obstruction. (b) The guide wire is replaced by an Amplatz stiff guide wire to straighten the tortuous rectosigmoid region, and the delivery system is introduced. (c) The stent is initially deployed at the proximal portion of the lesion. (d) The stent is fully expanded and symmetric in diameter throughout its length.

View larger version (157K): [in a new window]   Figure 1d. Illustrations depict placement of the stent. (a) The guide wire and catheter are advanced through the area of obstruction. (b) The guide wire is replaced by an Amplatz stiff guide wire to straighten the tortuous rectosigmoid region, and the delivery system is introduced. (c) The stent is initially deployed at the proximal portion of the lesion. (d) The stent is fully expanded and symmetric in diameter throughout its length.

View larger version (128K): [in a new window]   Figure 2a. Barium enema studies in a 69-year-old man. (a) Right anterior oblique study shows a tight colorectal stenosis (arrow). (b) After the hydrophilic guide wire and an angiographic catheter were guided through the area of occlusion, nonionic contrast material was injected to define the anatomy of the proximal and distal regions of the lesion (arrows) and to rule out colonic perforation. (c) The guide wire is replaced by an Amplatz stiff guide wire, and the delivery system has been introduced. (d) Radiograph reveals deployment of the stent (arrows), which is fully expanded.

View larger version (149K): [in a new window]   Figure 2b. Barium enema studies in a 69-year-old man. (a) Right anterior oblique study shows a tight colorectal stenosis (arrow). (b) After the hydrophilic guide wire and an angiographic catheter were guided through the area of occlusion, nonionic contrast material was injected to define the anatomy of the proximal and distal regions of the lesion (arrows) and to rule out colonic perforation. (c) The guide wire is replaced by an Amplatz stiff guide wire, and the delivery system has been introduced. (d) Radiograph reveals deployment of the stent (arrows), which is fully expanded.

View larger version (159K): [in a new window]   Figure 2c. Barium enema studies in a 69-year-old man. (a) Right anterior oblique study shows a tight colorectal stenosis (arrow). (b) After the hydrophilic guide wire and an angiographic catheter were guided through the area of occlusion, nonionic contrast material was injected to define the anatomy of the proximal and distal regions of the lesion (arrows) and to rule out colonic perforation. (c) The guide wire is replaced by an Amplatz stiff guide wire, and the delivery system has been introduced. (d) Radiograph reveals deployment of the stent (arrows), which is fully expanded.

View larger version (146K): [in a new window]   Figure 2d. Barium enema studies in a 69-year-old man. (a) Right anterior oblique study shows a tight colorectal stenosis (arrow). (b) After the hydrophilic guide wire and an angiographic catheter were guided through the area of occlusion, nonionic contrast material was injected to define the anatomy of the proximal and distal regions of the lesion (arrows) and to rule out colonic perforation. (c) The guide wire is replaced by an Amplatz stiff guide wire, and the delivery system has been introduced. (d) Radiograph reveals deployment of the stent (arrows), which is fully expanded.

View larger version (153K): [in a new window]   Figure 3. Digitalized radiograph obtained in a 71-year-old woman immediately after stent deployment shows an "apple-core" configuration of the lesion (arrows). The stent was delivered in an adequate location that allowed retrograde opacification of the descending colon.

View larger version (189K): [in a new window]   Figure 4. Follow-up radiograph obtained at 24 hours after stent implantation reveals increased expansion of the stent (arrow). The 75-year-old man later underwent scheduled surgical resection of the tumor and creation of a primary colorectal anastomosis.

View larger version (144K): [in a new window]   Figure 5. CT scan obtained in a 68-year-old man shows a patent stent (arrow) and allows adequate staging of the tumor. The stent does not induce artifacts.