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• W2912474534 abstract "We present a case in which complications of progressive adenocarcinoma of the colon including obstruction of the duodenum, bile duct, and colon and a coloduodenal fistula (CDF) causing abdominal pain, jaundice and feculent emesis were palliated with multiple self-expanding metal stents (SEMS) in a patient without operative options. A 49-year-old woman undergoing chemotherapy for metastatic adenocarcinoma of the hepatic flexure of the colon presented with persistent foul-smelling emesis, abdominal pain and jaundice. Abdominal CT imaging demonstrated interval growth of the mass resulting in duodenal and biliary obstruction. EGD revealed a distended stomach filled with partially digested food and solid stool and an obstructing ulcerated stricture and a punctate hole in the second portion of the duodenum. A fistulous tract between the duodenum and right colon was demonstrated after injecting contrast into the hole under fluoroscopy. After placement of an uncovered biliary SEMS across the biliary stricture, an uncovered duodenal SEMS was placed over a guidewire across the duodenal stricture. Her symptoms resolved and bilirubin normalized and she resumed chemotherapy; however, three weeks later she presented with similar symptoms. Repeat CT imaging demonstrated progressive growth of the mass with obstruction at the hepatic flexure. EGD revealed obstructing tumor in-growth through the duodenal stent which was treated with a through-the-scope, fully-covered esophageal SEMS immobilized with stitches in the gastric antrum. An obstructing ulcerated mass in the proximal colon was identified during colonoscopy and, after passing a biliary guidewire, a colonic SEMS was placed. Again, her symptoms resolved permitting resumption of chemotherapy for an additional four months before she died. CDFs are uncommon, most often occurring as a complication of locally advanced colon adenocarcinoma. Patients may present with GI hemorrhage, abdominal pain, diarrhea or, as in this case, feculent emesis with foul eructation. Historically CDFs were operatively managed either with curative intent (e.g. partial colectomy with duodenoduodenostomy or pancreaticoduodenectomy) or, more commonly, with a palliative gastrojejunal bypass. For patients needing palliation of a CDF who are poor surgical candidates, or have life expectancy of less than 6 months, or prefer to not risk the morbidity or mortality of surgery, endoscopy with placement of enteral stents may be an attractive alternative.Figure: Stool in duodenum.Figure: Coloduodenal fistula (black arrow) on CT imaging with IV contrast.Figure: Frontal supine radiograph with biliary, duodenal and colonic stent." @default.
• W2912474534 created "2019-02-21" @default.
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• W2912474534 date "2017-10-01" @default.
• W2912474534 modified "2023-09-26" @default.
• W2912474534 title "Endoscopic Palliative Management of an Obstructing Colonic Malignancy Complicated by a Coloduodenal Fistula in a Patient With Feculent Emesis" @default.
• W2912474534 doi "https://doi.org/10.14309/00000434-201710001-02117" @default.
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