Arterial-colonic fistula secondary to colonic stent erosion into the left external iliac artery

Abstract

Self-expandable metal stent (SEMS) are widely utilized as a bridge to surgical intervention and for palliative treatment of malignant bowel obstructions. The risk of complications associated with SEMS is low in well-selected patients. Stent erosion is a rare but serious adverse event that is associated with high morbidity and mortality. Here, we report the case of a 74-year-old patient with a colonic obstruction secondary to a pelvic mass that was treated with SEMS and radiotherapy, who developed a partial thickness stent erosion and recurrent hematochezia 6 years after placement. Endoscopic retrieval was not technically feasible. During attempted surgical resection, massive hemorrhage occurred from a colonic-arterial fistula to the left external iliac artery resulting in death. While SEMS remain an effective, minimally invasive approach for the management of bowel obstructions, prolonged in-situ lifetime may confer an increased risk of serious adverse events including erosion and fistula formation.

Intravascular placement and migration of a colonic stent into the inferior mesenteric vein

“…Erosion of SEMS into adjacent structures (incidence 1.5–6.4%) may cause significant morbidity and mortality, making this one of the most feared complications of SEMS placement. Risk factors include deeper tumour depth, prior radiation and balloon dilation prior to stent placement 2 3 7. Unusual examples include stent erosion into the bladder requiring pelvic exenteration6 and erosion into the external iliac artery following chemotherapy 7.…”

“…Risk factors include deeper tumour depth, prior radiation and balloon dilation prior to stent placement 2 3 7. Unusual examples include stent erosion into the bladder requiring pelvic exenteration6 and erosion into the external iliac artery following chemotherapy 7. These unusual and complex cases usually manifest as late complications.…”