Small bowel obstruction due to migrated oesophageal metal stent

Abstract

Introduction and importance

Endoscopic oesophageal stents have numerous applications, including palliative management for unresectable oesophageal cancer, treatment of benign strictures and blocking early oesophageal perforations. However a significant limitation of fully covered self-expandable metallic stents (FC-SEMs) is their risk of migration. While oesophageal stenting is generally safe, it carries risks of mainly minor complications and a few major complications like tracheoesophageal fistulae, intestinal perforation, and, very rarely, intestinal obstruction due to stent migration. We hereby describe an instance of the last complication.

Case presentation

A 48-year-old male with chronic kidney disease and hypertension presented with Boerhaave's syndrome which was successfully managed with FC-SEMs placement. He was lost to follow-up, but returned 8 months later presented with features of intestinal obstruction. Imaging revealed migrated FC-SEMs in the mid-jejunum with features of small bowel obstruction. After conservative management failed, he underwent exploratory laparotomy and stent retrieval. He had an uneventful post-operative recovery.

Clinical discussion

Boerhaave syndrome, a rare spontaneous oesophageal perforation, has seen evolving management strategies, from surgical repair to minimally invasive endoscopic interventions like self-expandable metallic stents (SEMs). While SEMs effectively manage perforations, migration remains a major complication, influenced by stent type and placement location. In this case, a migrated stent caused small bowel obstruction, necessitating surgical retrieval. This highlights the need for careful stent selection, close follow-up, and individualized management to prevent severe complications.

Conclusion

Migrating, covered SEMs, placed for oesophageal perforation, may cause intestinal obstruction necessitating surgical retrieval.