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• W2996240875 abstract "A 63-year-old woman with stage IV colon cancer presented with 3 days of abdominal pain, nausea, and vomiting. CT revealed a circumferential mass in the descending colon with proximal distension and cecal diameter of 10 cm (A). After discussion with the surgery and oncology departments, colonoscopy was performed, revealing a 4-cm × 2-mm stricture in the proximal descending colon (A). A 25-mm × 8-cm uncovered metal stent was placed and confirmed in good position under fluoroscopy (B). Owing to the severity of the stricture, she was advised to maintain a low-fiber diet with stool softeners to have 2 soft stools per day. Three days later, she presented again to the hospital for recurrent symptoms. She reported noncompliance with the low-fiber diet and bowel regimen. Repeated CT revealed proximal colonic distension and the stent in good position across the stricture, with a small circular radiolucent lesion in the middle of the stent (C). Given the concern for stent obstruction, repeat colonoscopy was performed and revealed cherry pits within the stent lumen, causing obstruction (C). The stent was swept multiple times with a balloon catheter over a guidewire, and multiple cherry pits were removed. Balloon dilation was then performed with adequate flow of stool (D). She was discharged the next day with resolution of symptoms. All authors disclosed no financial relationships relevant to this publication. Commentary There is no universally agreed-upon diet after colonic stent placement. In my practice, I typically advise patients to slowly advance to a low-residue diet and avoid bulk vegetable matter, for fear of clogging the stent. I also advise patients to adhere to a daily laxative regimen. Still, I have had partners who allowed patients to resume a full diet and did not institute a daily laxative. This case illustrates the perils of a high-fiber, high-residue diet; this patient experienced a recurrent large-bowel obstruction from cherry pits, essentially causing a logjam at the level of the stent. It is notable that even 72 hours later, the stent was far from fully effaced and had what can only be called a very narrow lumen. This may speak to the severity of the stenosis itself. This patient, we are told, was advised to adhere to a low-residue diet, but clearly she failed to do so. Hopefully, she will be more adherent going forward. Douglas G. Adler, MD, FASGE, GIE Senior Associate Editor, University of Utah School of Medicine, Salt Lake City, Utah Mohamed O. Othman, MD, Associate Editor for Focal Points" @default.
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• W2996240875 date "2020-05-01" @default.
• W2996240875 modified "2023-09-25" @default.
• W2996240875 title "Cherry pits causing colonic obstruction" @default.
• W2996240875 doi "https://doi.org/10.1016/j.gie.2019.12.007" @default.
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