Nitinol self expandable metal stents are increasingly utilised for malignant obstruction in the proximal gastrointestinal tract. We describe a case in which repeated fracture of proximal duodenal stents with dissolution of the nitinol wire skeleton and covering membranes occurred in a long term cancer survivor. This necessitated placement of 4 stents for symptom control and to allow oral feeding until the patient's death 20 months after the initial stent was inserted. Fracture of gastric and duodenal stents has rarely been described previously, some incidences of which were considered due to mechanical causes. Dissolution of stent metal skeletons has not previously been recognised in gastroduodenal stents but has been described in an oesophageal stent subject to reflux of gastric content and a biochemical mechanism has been proposed. With modern oncological treatment the prospect of patients outliving their stents is increasing and the need for repeat procedures should form part of the consent process.
Gastric Outlet Obstruction ; Gastrointestinal Tract ; Humans ; Incidence ; Membranes ; Prosthesis Failure ; Radiology, Interventional ; Self Expandable Metallic Stents ; Skeleton ; Stents ; Survivors

Percutaneous cecostomy is an uncommon procedure but is reported as an effective temporising measure to achieve acute decompression of bowel obstruction. It has been reported as a safe procedure in the setting of bowel obstruction providing relief of symptoms. The insertion of a cecostomy in the distal colon is not routinely advised as it will not allow passage of formed faeces. Cases of antegrade stenting of proximal colonic obstruction via cecostomy have been described; however, antegrade stenting of the distal colon from access in the ascending colon can be technically challenging. We describe a case of a percutaneous colostomy inserted temporally at the splenic flexure, which provided close access to an obstructing descending colonic tumour, allowing definitive management with placement of a colonic stent. This technical feasibility case provides evidence that a temporary cecostomy placed in the distal colon can be performed as a measure to facilitate definitive management.
Cecostomy ; Colon* ; Colon, Ascending ; Colon, Descending ; Colon, Transverse ; Colostomy ; Decompression ; Stents*