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Gennaro Martines, Ippazio Ugenti, Maurogiovanni Giovanni, Riccardo Memeo, Onofrio Caputi Iambrenghi, Anastomotic stricture in Crohn's disease: Bridge to surgery using a metallic endoprosthesis, Inflammatory Bowel Diseases, Volume 14, Issue 2, 1 February 2008, Pages 291–292, https://doi.org/10.1002/ibd.20268
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To the Editor:
The use of stents for benign intestinal obstruction is controversial, but they are effective in treating anastomotic strictures, showing long-term patency.1 Few reports have described the use of self-expanding metallic stents (SEMS) in fibrostenotic Crohn's disease (CD) with obstruction refractory to anti-inflammatory medical therapy.
We report a case of bowel obstruction due to stricture of an ileocolic anastomosis, treated with a metallic enteral endoprosthesis as a “bridge to surgery.”
A 45-year-old white man with CD had undergone right hemicolectomy with ileocolic L–L anastomosis 7 years earlier for progressively worsening obstruction after a long period of unsuccessful medical therapy and total parenteral nutrition.
After surgery, his disease was quiescent under continuous mesalamine therapy until 3 weeks before admission. He presented with abdominal pain, vomiting, and abdominal distension. Medical parenteral treatment and gastric drainage failed to improve the symptoms. Total colonoscopy showed stenosis proximal to the ileocolic anastomosis; simultaneously performed balloon dilatation obtained partial relief of the obstruction lasting only 1 week. The patient was admitted to our surgical department in a cachectic state, with hypoalbuminemia (2.0 g/dL). Abdominal fluoroscopy showed air-liquid levels due to distension of the small bowel but no sign of intestinal perforation.
