The following is the basic knowledge that necessary for the treatment of complications of colorectal stent placement.
It is important to correctly judge the indications for the safe operation of colorectal stent placement. prophylaxis of colorectal stent placement should be avoided due to the possibility of complications.
(1) Cases of longer stenosis and multiple stenoses caused by large tumors
In such cases, the possibility of perforation after colorectal stent placement is high, especially in the case of external pressure tumors. It is necessary to pay attention to the presence of multiple stenoses, and whether there is any lesion on the side. Surgery is recommended when there are multiple stenoses (more than 3 stenoses).
(2) Cases of obvious inflammation or fistula
It is often necessary to consider the possibility of sudden intestine rupture when there is severe occlusive enteritis. The increase of white blood cells, CRP and lactic acid has a suggestive function, early surgery should be considered when severe abdominal pain and peritoneal irritation occur. In fact, judgment is not easy in many cases. The expansion of the cecum and ascending colon to more than 10 cm on CT is and the presence of emphysema in the intestinal wall are important references.
(3) Cases of the rectum (Rb) next to the anal margin
Although there is no clear standard due to individual differences, the colorectal stent should be carefully placed within 3 cm from the anal margin. The case of intense pain caused by stents that close to the dentate line is one of the contraindications.
(1) Colorectal stent placement should be considered early after the onset of intestinal obstruction. It should be recognized that malignant colorectal stenosis of the colon is a condition that may deteriorate rapidly.
(2) Colorectal stent placement must be done under fluoroscopy. The guidewire should be passed through the narrow section and then fed into the pusher. Most of the intraoperative perforations are caused by the guidewire, so it is important to be careful during the operation. When inserting the guidewire, ERCP is required for imaging and try to confirm the narrow intestinal tube while advancing.
(3) In general, the stenosis is not expanded by the ballon to avoid increasing the possibility of perforation. The front end of the pusher is thin so that it can pass through the narrow section without expanding.
(4) The lesion can be marked with a clip on the anal side in advance. It is not necessary to use endoscopic images to confirm the position of the colorectal stent in the part with poor endoscopic control. The position can be adjusted with the help of the perspective image. Therefore, marking is necessary.