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Metallic Stents in the Treatment of Benign Diseases of the Colon: Preliminary Experience in 10 Cases¹

¹ From the Departments of Radiology (L.P., I.P., H.G.), Surgery (R.F.L.), and Gastroenterology (E.M.), University Getafe Hospital, Carretera de Toledo Km 12,5, 28905 Getafe, Madrid, Spain. Received April 30, 2001; revision requested June 5; revision received September 10; accepted October 16. Address correspondence to L.P. (e-mail: laura.paul@teleline.es).

View larger version (104K): [in a new window]   Figure 1a. Patient 1. (a) Right anterior oblique radiograph obtained from barium enema study performed in 73-year-old man who presented with abdominal pain and fever shows stenosis and spiculation (arrows) of sigmoid colon; these radiologic signs are consistent with a diagnosis of diverticulitis. (b) Transverse nonenhanced CT scan of pelvis shows parasigmoid abscess (A) that was drained with a catheter. (c) Oblique barium enema radiograph. After the abscess persisted for 1 months despite drainage and antibiotic therapy, a coated stent (arrowhead) was placed across the affected segment of the sigmoid colon. (d) Transverse nonenhanced CT scan of the pelvis obtained 6 days after stent placement shows resolution of abscess. Note stent (P) position across the affected sigmoid colon segment. (e) Frontal single-contrast barium enema radiograph. Patient was readmitted 5 months later with abdominal pain and rectal bleeding. At colonoscopy, the endoprosthesis was visualized in a crosswise position with one end protruding into the colonic wall. Radiograph shows rapid refilling of small-bowel loops that is probably due to the presence of a fistula in the region of the stent (P). The fistula could not be precisely located, but there was practically no filling of the descending colon (DC) beyond the stent.

View larger version (132K): [in a new window]   Figure 1b. Patient 1. (a) Right anterior oblique radiograph obtained from barium enema study performed in 73-year-old man who presented with abdominal pain and fever shows stenosis and spiculation (arrows) of sigmoid colon; these radiologic signs are consistent with a diagnosis of diverticulitis. (b) Transverse nonenhanced CT scan of pelvis shows parasigmoid abscess (A) that was drained with a catheter. (c) Oblique barium enema radiograph. After the abscess persisted for 1 months despite drainage and antibiotic therapy, a coated stent (arrowhead) was placed across the affected segment of the sigmoid colon. (d) Transverse nonenhanced CT scan of the pelvis obtained 6 days after stent placement shows resolution of abscess. Note stent (P) position across the affected sigmoid colon segment. (e) Frontal single-contrast barium enema radiograph. Patient was readmitted 5 months later with abdominal pain and rectal bleeding. At colonoscopy, the endoprosthesis was visualized in a crosswise position with one end protruding into the colonic wall. Radiograph shows rapid refilling of small-bowel loops that is probably due to the presence of a fistula in the region of the stent (P). The fistula could not be precisely located, but there was practically no filling of the descending colon (DC) beyond the stent.

View larger version (124K): [in a new window]   Figure 1c. Patient 1. (a) Right anterior oblique radiograph obtained from barium enema study performed in 73-year-old man who presented with abdominal pain and fever shows stenosis and spiculation (arrows) of sigmoid colon; these radiologic signs are consistent with a diagnosis of diverticulitis. (b) Transverse nonenhanced CT scan of pelvis shows parasigmoid abscess (A) that was drained with a catheter. (c) Oblique barium enema radiograph. After the abscess persisted for 1 months despite drainage and antibiotic therapy, a coated stent (arrowhead) was placed across the affected segment of the sigmoid colon. (d) Transverse nonenhanced CT scan of the pelvis obtained 6 days after stent placement shows resolution of abscess. Note stent (P) position across the affected sigmoid colon segment. (e) Frontal single-contrast barium enema radiograph. Patient was readmitted 5 months later with abdominal pain and rectal bleeding. At colonoscopy, the endoprosthesis was visualized in a crosswise position with one end protruding into the colonic wall. Radiograph shows rapid refilling of small-bowel loops that is probably due to the presence of a fistula in the region of the stent (P). The fistula could not be precisely located, but there was practically no filling of the descending colon (DC) beyond the stent.

View larger version (137K): [in a new window]   Figure 1d. Patient 1. (a) Right anterior oblique radiograph obtained from barium enema study performed in 73-year-old man who presented with abdominal pain and fever shows stenosis and spiculation (arrows) of sigmoid colon; these radiologic signs are consistent with a diagnosis of diverticulitis. (b) Transverse nonenhanced CT scan of pelvis shows parasigmoid abscess (A) that was drained with a catheter. (c) Oblique barium enema radiograph. After the abscess persisted for 1 months despite drainage and antibiotic therapy, a coated stent (arrowhead) was placed across the affected segment of the sigmoid colon. (d) Transverse nonenhanced CT scan of the pelvis obtained 6 days after stent placement shows resolution of abscess. Note stent (P) position across the affected sigmoid colon segment. (e) Frontal single-contrast barium enema radiograph. Patient was readmitted 5 months later with abdominal pain and rectal bleeding. At colonoscopy, the endoprosthesis was visualized in a crosswise position with one end protruding into the colonic wall. Radiograph shows rapid refilling of small-bowel loops that is probably due to the presence of a fistula in the region of the stent (P). The fistula could not be precisely located, but there was practically no filling of the descending colon (DC) beyond the stent.

View larger version (126K): [in a new window]   Figure 1e. Patient 1. (a) Right anterior oblique radiograph obtained from barium enema study performed in 73-year-old man who presented with abdominal pain and fever shows stenosis and spiculation (arrows) of sigmoid colon; these radiologic signs are consistent with a diagnosis of diverticulitis. (b) Transverse nonenhanced CT scan of pelvis shows parasigmoid abscess (A) that was drained with a catheter. (c) Oblique barium enema radiograph. After the abscess persisted for 1 months despite drainage and antibiotic therapy, a coated stent (arrowhead) was placed across the affected segment of the sigmoid colon. (d) Transverse nonenhanced CT scan of the pelvis obtained 6 days after stent placement shows resolution of abscess. Note stent (P) position across the affected sigmoid colon segment. (e) Frontal single-contrast barium enema radiograph. Patient was readmitted 5 months later with abdominal pain and rectal bleeding. At colonoscopy, the endoprosthesis was visualized in a crosswise position with one end protruding into the colonic wall. Radiograph shows rapid refilling of small-bowel loops that is probably due to the presence of a fistula in the region of the stent (P). The fistula could not be precisely located, but there was practically no filling of the descending colon (DC) beyond the stent.

View larger version (155K): [in a new window]   Figure 2a. Patient 3. (a) Lateral cystogram obtained 40 days after ileostomy in 57-year-old man with a rectovesical fistula after surgery for cancer of sigmoid colon (fistula between rectosigmoid colon anastomosis and neobladder [B] created by using the Studer technique) shows a persisting rectovesical fistula (F) with passage of contrast material. R = rectum. (b) Lateral postvoiding cystogram obtained 40 days after stent (arrowheads) placement in rectum (R) shows the fistula between the neobladder (B) and the rectum is completely sealed. The ileal loop (I) also is shown. Barium enema radiograph (not shown) also showed absence of fistula.

View larger version (140K): [in a new window]   Figure 2b. Patient 3. (a) Lateral cystogram obtained 40 days after ileostomy in 57-year-old man with a rectovesical fistula after surgery for cancer of sigmoid colon (fistula between rectosigmoid colon anastomosis and neobladder [B] created by using the Studer technique) shows a persisting rectovesical fistula (F) with passage of contrast material. R = rectum. (b) Lateral postvoiding cystogram obtained 40 days after stent (arrowheads) placement in rectum (R) shows the fistula between the neobladder (B) and the rectum is completely sealed. The ileal loop (I) also is shown. Barium enema radiograph (not shown) also showed absence of fistula.

View larger version (75K): [in a new window]   Figure 3a. Patient 4. (a) Frontal single-contrast barium enema radiograph obtained in 63-year-old man who had undergone surgery for cancer of descending colon and presented with pain, fever, and inability to defecate shows fistula (extravasation of contrast material [C]) with moderate stenosis (arrows) in region of the surgical anastomosis. (b) Frontal barium enema radiograph obtained 2 months after placement of coated stent (arrowhead) shows substantial improvement of fistula. Minimal filling of a small-bowel loop (arrow) is visible; this had not been seen previously and probably was caused by a prolongation of the original fistula.

View larger version (128K): [in a new window]   Figure 3b. Patient 4. (a) Frontal single-contrast barium enema radiograph obtained in 63-year-old man who had undergone surgery for cancer of descending colon and presented with pain, fever, and inability to defecate shows fistula (extravasation of contrast material [C]) with moderate stenosis (arrows) in region of the surgical anastomosis. (b) Frontal barium enema radiograph obtained 2 months after placement of coated stent (arrowhead) shows substantial improvement of fistula. Minimal filling of a small-bowel loop (arrow) is visible; this had not been seen previously and probably was caused by a prolongation of the original fistula.

View larger version (118K): [in a new window]   Figure 4a. Patient 6. (a) Lateral barium enema radiograph obtained in 60-year-old woman shows rectovaginal fistula with contrast material leakage into vagina (V) and uterus (U) at an end-to-side rectosigmoid colon anastomosis (arrows). (b) Frontal barium enema radiograph shows large diameter of colon in region of fistula (arrowheads) makes it difficult for stent to fit snugly. (c) Lateral barium enema radiograph shows fistula (arrow) persisted despite placement of stent (P) across the anastomosis. Contrast material appears to be flowing between the stent and the colonic wall and thus passing through the fistula.

View larger version (104K): [in a new window]   Figure 4b. Patient 6. (a) Lateral barium enema radiograph obtained in 60-year-old woman shows rectovaginal fistula with contrast material leakage into vagina (V) and uterus (U) at an end-to-side rectosigmoid colon anastomosis (arrows). (b) Frontal barium enema radiograph shows large diameter of colon in region of fistula (arrowheads) makes it difficult for stent to fit snugly. (c) Lateral barium enema radiograph shows fistula (arrow) persisted despite placement of stent (P) across the anastomosis. Contrast material appears to be flowing between the stent and the colonic wall and thus passing through the fistula.

View larger version (129K): [in a new window]   Figure 4c. Patient 6. (a) Lateral barium enema radiograph obtained in 60-year-old woman shows rectovaginal fistula with contrast material leakage into vagina (V) and uterus (U) at an end-to-side rectosigmoid colon anastomosis (arrows). (b) Frontal barium enema radiograph shows large diameter of colon in region of fistula (arrowheads) makes it difficult for stent to fit snugly. (c) Lateral barium enema radiograph shows fistula (arrow) persisted despite placement of stent (P) across the anastomosis. Contrast material appears to be flowing between the stent and the colonic wall and thus passing through the fistula.

View larger version (79K): [in a new window]   Figure 5a. Patient 10. (a) Frontal barium enema radiograph obtained in 53-year-old man with bowel obstruction following surgery for diverticulitis shows occlusion (O) at level of rectosigmoid colon anastomosis. (b) Frontal barium enema radiograph shows stent placement at rectosigmoid junction after successful resolution of obstruction. This view of stent across the anastomosis shows narrower expansion (arrows) of the middle third of the rectosigmoid colon due to the effect of the tight stricture. (c) Frontal barium enema radiograph obtained after expulsion of stent 48 hours after placement and resolution of obstruction shows larger diameter (arrows) of anastomosis; however, clinical symptoms of obstruction recurred 1 week later.

View larger version (107K): [in a new window]   Figure 5b. Patient 10. (a) Frontal barium enema radiograph obtained in 53-year-old man with bowel obstruction following surgery for diverticulitis shows occlusion (O) at level of rectosigmoid colon anastomosis. (b) Frontal barium enema radiograph shows stent placement at rectosigmoid junction after successful resolution of obstruction. This view of stent across the anastomosis shows narrower expansion (arrows) of the middle third of the rectosigmoid colon due to the effect of the tight stricture. (c) Frontal barium enema radiograph obtained after expulsion of stent 48 hours after placement and resolution of obstruction shows larger diameter (arrows) of anastomosis; however, clinical symptoms of obstruction recurred 1 week later.

View larger version (111K): [in a new window]   Figure 5c. Patient 10. (a) Frontal barium enema radiograph obtained in 53-year-old man with bowel obstruction following surgery for diverticulitis shows occlusion (O) at level of rectosigmoid colon anastomosis. (b) Frontal barium enema radiograph shows stent placement at rectosigmoid junction after successful resolution of obstruction. This view of stent across the anastomosis shows narrower expansion (arrows) of the middle third of the rectosigmoid colon due to the effect of the tight stricture. (c) Frontal barium enema radiograph obtained after expulsion of stent 48 hours after placement and resolution of obstruction shows larger diameter (arrows) of anastomosis; however, clinical symptoms of obstruction recurred 1 week later.