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DOI: 10.1055/s-2002-25296
© Georg Thieme Verlag Stuttgart · New York
Wallstent and Unusual Gastrointestinal Bleeding
M. Balkan, M.D.
Department of Surgery
Gülhane Military Medical Academy
Etlik 06018
Ankara
Turkey
Fax: + 90-312-3045002
Email: mujdatbalkan@yahoo.com
Publication History
Publication Date:
22 April 2002 (online)
The endoprosthesis materials currently in use, with low friction coefficients maintaining biliary passage, are Teflon, polyethylene, polyurethane, and Percuflex catheters. In order to reduce the obstruction and displacement rates, expandable metal stents have been developed and tested in cases of malignant biliary disease [1] [2] [3] [4] [5]. Self-expanding metallic stents create an expansion force that gives them the required diameter after they are placed in the stricture (Figure [1]). This case report emphasizes the need for careful placement of metallic stents in order to avoid the complication of intestinal wall erosion.
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 1 Expandable metal stent made of constricted round steel wire with a diameter of 0.018 inches
A 58-year-old man was referred with jaundice, weight loss, vomiting, and pain. The cytological findings after a gastrojejunoscopic biopsy revealed a lower biliary neoplasm, with routine biochemical and radiological investigations. A pyloric-preserving Whipple operation was carried out. Five months after the operation, a self-expanding biliary Wallstent was placed, due to the development of biliary obstruction. On the fifth day after the stent had been placed, abdominal pain started. While the cause of the pain was still being investigated, gastrointestinal bleeding of more than five units occurred on the fifteenth day after stent placement, reducing the patient's hematocrit to 30 % from 42 % (Figure [2]). An endoscopic examination revealed an ulcer crater traversing the choledochojejunal anastomosis, caused by stent irritation of the opposite intestinal wall. The Wallstent was removed, and no further mishaps occurred after its removal. Twenty days after it had been removed, the patient died of sepsis. Proper stent placement is thus essential in order to avoid fatal complications.
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 2 Stent-induced bleeding in an erosion on the jejunal wall
References
- 1 Gillams A, Dick R, Rooley J S, Wallsten H, El-Din A.. Self-expandable stainless steel braided endoprosthesis for biliary strictures. Radiology. 1990; 174 137-140
- 2 Gottlieb K, Sherman S, Lehman G A.. Therapeutic biliary endoscopy. Endoscopy. 1996; 28 113-130
- 3 Schöfl R, Brownstone E, Reichel W, Fommat W, Doblhofer F, Samec H J. et al. . Malignant bile duct obstruction: experience with self-expanding metal endoprostheses (Wallstents) in Austria. Endoscopy. 1994; 26 592-596
- 4 Hoepffner N, Foerster E C, Högemann B, Domschke W.. Long-term experience in Wallstent therapy for malignant choledochal stenosis. Endoscopy. 1994; 26 597-602
- 5 Van Berkel A M, Bergman J JGHM, Waxman I, Andres P, Huibregtse K.. Wallstents for malignant biliary obstruction. Endoscopy. 1996; 28 418-421
M. Balkan, M.D.
Department of Surgery
Gülhane Military Medical Academy
Etlik 06018
Ankara
Turkey
Fax: + 90-312-3045002
Email: mujdatbalkan@yahoo.com
References
- 1 Gillams A, Dick R, Rooley J S, Wallsten H, El-Din A.. Self-expandable stainless steel braided endoprosthesis for biliary strictures. Radiology. 1990; 174 137-140
- 2 Gottlieb K, Sherman S, Lehman G A.. Therapeutic biliary endoscopy. Endoscopy. 1996; 28 113-130
- 3 Schöfl R, Brownstone E, Reichel W, Fommat W, Doblhofer F, Samec H J. et al. . Malignant bile duct obstruction: experience with self-expanding metal endoprostheses (Wallstents) in Austria. Endoscopy. 1994; 26 592-596
- 4 Hoepffner N, Foerster E C, Högemann B, Domschke W.. Long-term experience in Wallstent therapy for malignant choledochal stenosis. Endoscopy. 1994; 26 597-602
- 5 Van Berkel A M, Bergman J JGHM, Waxman I, Andres P, Huibregtse K.. Wallstents for malignant biliary obstruction. Endoscopy. 1996; 28 418-421
M. Balkan, M.D.
Department of Surgery
Gülhane Military Medical Academy
Etlik 06018
Ankara
Turkey
Fax: + 90-312-3045002
Email: mujdatbalkan@yahoo.com
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 1 Expandable metal stent made of constricted round steel wire with a diameter of 0.018 inches
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Figure 2 Stent-induced bleeding in an erosion on the jejunal wall