Expandible metallic stents may be used in the treatment of left-sided colonic obstruction as an alternative to emergency colostomy. These devices have been shown to effectively produce rapid decompression of the colon, with a decrease in morbidity and mortality over conventional surgical therapy [64-67]. Stent placements may be performed for palliation in patients with metastatic disease or unresectable tumors and in those who are poor surgical candidates. Stenting may also be a temporary measure: to provide immediate bowel decompression or to allow for bowel preparation, tumor staging, and improvement in the patient's general condition, thus permitting a one-stage procedure (with primary anastomosis and avoidance of a colostomy) rather than a two- or three-stage procedure. Stents may also be used for the treatment of benign colonic strictures and colovesical fistulas. Perforation at the time of presentation is a contraindication to stent placement.

Colonic stents may be placed endoscopically or with fluoroscopic guidance alone by the interventional radiologist [64]. Uncovered stents are usually used. Before stent placement, it is helpful to obtain a contrast enema to determine the location, caliber, and length of the obstructing lesion [65]. Water-soluble contrast media is preferable to barium because barium may interfere with visualization during endoscopy, and it is not necessary to demonstrate mucosal detail. After stent placement, plain films and a water-soluble contrast enema may be obtained to confirm stent position and patency. Plain films may serve as a baseline to evaluate for stent migration in the future (Fig. 6.37). Complications include stent malposition, stent migration (including spontaneous expulsion of the stent), stent obstruction (from tumor ingrowth or fecal impaction), and colonic perforation. Colonic perforation may not require surgery in all cases. Stent obstruction by tumor growth can be avoided by using covered stents; however stent migra-

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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