Angioembolization of rectal stent induced inferior mesenteric artery pseudoaneurysm

Kaushal Yadav; Akash Bansal; Kartar Singh Yadav

doi:10.18203/2320-6012.ijrms20233049

Authors

Kaushal Yadav Clinical Lead Department of Surgical Oncologogy, Narayana Superspeciality Hospital, Gurugram, Haryana, India
Akash Bansal Department of Intervention Radiology, Narayana Superspeciality Hospital, Gurugram, Haryana, India
Kartar Singh Yadav Shanti Yadav Hospital, Rewari, Haryana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20233049

Keywords:

Colorectal cancer, Malignant intestinal obstruction, Rectal stent, Angioembolization

Abstract

Bleeding is a lesser-known complication of rectal self-expandable metal stents (SEMS). Most of these bleedings are self-limiting. Life threatening bleeding as a complication of SEMS reported only rarely. In the present paper, we are reporting a rare case of near fatal intraluminal bleeding from rectal SEMS. Traumatic pseudoaneurysm formed in superior rectal branch of the inferior mesenteric artery because of pressure induced by rectal stent. Severe bleeding leads to haemorrhagic shock. Patient was stabilized and angioembolization of pseudoaneurysm with superior rectal branch of inferior mesenteric artery was done. Bleeding stopped post procedure and patient discharged in stable condition. This case presentation highlights the fact that we should decide management strategy for a patient in multidisciplinary meeting and utilize the available resources in best possible ways. Though rectal stents are good alternatives, they have their own set of complications. These should be considered while deciding strategy for the upfront stoma versus rectal stent. For cases as in this article upfront stoma may have avoided the associated complication.

Metrics

Metrics Loading ...

References

Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl. 2008;90(3):181-6.

Han SH, Lee JH. Colonic stent-related complications and their management. Clin Endosc. 2014;47(5):415-9.

Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc. 2010;71:560-72.

Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg. 2007;94:1151-4.

Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum. 2004;47(7):1201-7.

Khattak YJ, Alam T, Shoaib RH, Sayani R, Tanveer-Ul H, Awais M. Endovascular Embolization of visceral artery pseudoaneurysms. Radiol Res Oractice, 2014;258954:6.

Athreya S, Moss J, Urquhart G, Edwards R, Downie A, Poon FW. Colorectal stenting for colonic obstruction: the indications, complications, effectiveness and outcome: 5 year review. Eur J Radiol. 2006;60:91-4.

Pérez Domínguez L, García Martínez MT, Cáceres Alvarado N, Toscano Novella A, Higuero Grosso AP, Casal Núñez JE. Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery. Cir Esp. 2014;92(9):604-8.

Suzuki N, Saunders BP, Thomas-Gibson S, Akle C, Marshall M, Halligan S. Colorectal stenting for malignant and benign disease: outcomes in colorectal stenting. Dis Colon Rectum. 2004;47(7):1201-7.

Clark JS, Buchanan GN, Khawaja AR, Rowe PH, Stoodley BJ, Saunders MP et al. Use of the Bard Memotherm self-expanding metal stent in the palliation of colonic obstruction. Abdom Imaging. 2003;28(4):518-24.

Mainar A, Tejero E, Maynar M, Ferral H, Castañeda-Zúñiga W. Colorectal obstruction: treatment with metallic stents. Radiology. 1996;198(3):761-4.

Choi JH, Lee YJ, Kim ES, Choi JH, Cho KB, Park KS et al. Covered self-expandable metal stents are more associated with complications in the management of malignant colorectal obstruction. Surg Endosc. 2013;27(9):3220-7.