Right-sided malignant colonic obstruction the use of a self expanding metal stent to facilitate laparoscopic surgery: A case report

The use of self expanding metals stents (SEMS) is established for management of left sided colonic obstruction. Its use for right sided malignant colonic obstructing (RMCO) tumours is less established with risks related to perforation of the colon. The use of a right sided colonic stent can be used to decompress the colon or small bowel and facilitate subsequent laparoscopic resection. A 68 year old gentleman presented with a history of right upper quadrant pain associated with fever, chills, loss of weight and abdominal distention. Examination revealed a tender right upper quadrant mass, workup revealed an empyema of the gallbladder with an associated colonic mass. The sepsis was controlled via percutaneous transhepatic cholecystomy and subsequent colonscopy revealed an obstructing hepatic flexure colonic tumour and multiple large left sided colonic polyps not amenable to snare excision. This tumour was stented at endoscopy under fluoroscopic control. The patient was taken to theatre and a laparoscopic subtotal colectomy with complete mesocolic excision and en bloc cholecystectomy was performed. In this case report, we demonstrate the use of SEMS for RMCO as a bridge for laparoscopic subtotal colectomy in a patient with right sided colonic cancer. This case also presented a unique challenge with the associated gallbladder empyema due to cystic duct obstruction. The stenting for RMCO and subsequent laparoscopic subtotal-colectomy was performed successfully for this patient, showing promise in the future utility of SEMS placement in RMCO. This report therefore adds to increasing evidence that emphasize the viability of SEMS in RMCO as a bridge to laparoscopic surgery for more proximal obstructions. According to our literature search, this is the third reported case of laparoscopic colectomy following SEMS for RMCO.