Bronchial Obstruction by Mediastinal Lymph Node Metastasis From Lung Cancer After Insertion of a Self-Expanding Metallic Stent for Esophageal Stenosis

Abstract

1 2 2 2 1 68 self-expanding metallic stent SEMS 18 SEMS SEMS SEMS 4 2005;45:739-744 ABSTRACT Background. Esophageal stenting has emerged as a common palliative treatment for esophageal stenosis due to malignant tumor. However, acute tracheo-brochial obstruction after esophageal self-expanding metallic stent SEMS placement is sometimes life-threatening and must be considered as an important adverse event. Recently cases of acute tracheo-bronchial obstruction after insertion of esophageal stents have been reported, and the use of tracheo-bronchial stents for treating adverse events has been a matter of recent contention. Case. We report the case of a 68-year-old man with lung cancer who underwent chemo-and radiotherapy. Esophageal stenosis developed due to relapse of mediastinal lymph node metastasis, and a SEMS was placed for esophageal stenosis. Acute bronchial obstruction induced by mediastinal lymph node migration occurred 18 h later. After SEMS placement for the bronchial obstruction, symptoms improved markedly. However he died of pneumonia due to esophago-tracheobroncheal fistula. Conclusion. When placement of SEMS is needed for malignant esophageal stenosis, prophylactic tracheo-bronchial stenting to avoid acute tracheo-bronchial obstruction should be discussed. Such cases must undergo strict follow-up until 4 weeks after esophageal SEMS placement. In addition, after placement of double stenting, the possibility of the development of JR 1 2 JR 453-0801 1