A Case of Inserting Two Self-expandable Metal Stents in Dual Malignant Colonic Obstructions / 대한소화기내시경학회지

Malignant colonic obstruction can lead an emergency operation for decompression, and this can cause post-operative complications due to poor bowel preparation. Self-expandable metal stent (SEMS) insertion is useful for avoiding an emergency operation and unnecessary complications. However, SEMS insertion for dual malignant colonic obstructions is very rare. We report here on a case of two SEMS that were inserted in dual malignant colonic obstructions caused by synchronous colon cancer. A 66-year-old man visited our hospital due to abdominal distension. Sigmoidoscopy and an abdominopelvic computerized tomographic (CT) scan revealed synchronous colon cancer at the splenic flexure and distal descending colon with dual obstruction. The initial SEMS insertion on the descending colon was not effective for decompression due to the proximal obstruction. After the second SEMS insertion on the splenic flexure through the first stent, all the signs and symptoms due to obstruction disappeared. SEMS insertion is considered to be useful for treating dual malignant colonic obstruction caused synchronous colon cancer.

Treatment of Multiple Colorectal Cancers

PURPOSE: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. METHODS: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. RESULTS: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33+/-11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. CONCLUSION: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer.