COLONIC PERFORATIONS AFTER SELF-EXPANDABLE METALLIC STENTING: TWO CASES REPORT.

The use of self-expandable metallic stents in colorectal stenoses, both benign and malignant, is a recently born treatment, quickly widespread because of its simplicity and therapeutic efficacy. It is particulary useful, like emergency temporany treatment, in malignant colonic obstruction; in these cases the temporary endoprosthesis positioning allows the intestinal transit and to overcame the emergengy phase. After patient conditions improvement, he can be operated and the endoprosthesis removed within operating specimen. In some particularly serious cases, when only a derivative intervention is mandatory because of the general conditions of the patient or the advanced stadium of the illness, stenting can also represent definitive palliative treatment. In fact, it allows contemporary resolution of the occlusion and of the physiopathologic alterations, with hospital cost reduction and a quality life imprevement for the patient thanks to the colestomy absence. In benign pathologies, self-expandable stents are used for a long time in the superior gastrointestinal and biliary tract; now stents have found employment also for the treatment of the post-operative fistula, intestinal diverticular occlusion and for the treatment of post-anastomotic or radiotherapy strictures. The Authors report two cases observed in emergency with complication determinated by positioning of colonic endoprosthesis for previous occlusive episode. The first case, a 56 year-old woman with a decubitus perforation occurred by stent, previously positioned with only palliative intent for a sigma-rectal metastatic cancer: in the second case, a 75 year-old man, the endoprosthesis had been positioned for a postoperative benign stricture of colorectal anastomosis for neoplasm: in this case the stent had determined a vescico-rectal fistula and after a new intestinal occlusion.