P1092 - Colonic Stenting and EUS-Guided EnteroColostomy in Malignant Small Bowel Obstruction: A Case Report

Award: Presidential Poster Award

Ritik M. Goyal, MBBS¹, Shivani Patel, MD¹, Mohamed Ismail, DO¹, Imran A. Qureshi, MD¹, Wajiha Khan, MD², Anand Shah, MD¹, Ahmed Al-Khazraji, MD¹, Kaveh Hajifathalian, MD^1
1Rutgers New Jersey Medical School, Newark, NJ; ²Rutgers New Jersey Medical School, Cartaret, NJ

Introduction: Malignant Small Bowel Obstruction (MSBO) is a debilitating complication of intra-abdominal malignancies, characterized by symptoms such as intractable nausea, vomiting, and abdominal pain. Surgical intervention becomes necessary for symptom management, although postoperative re-obstruction rates are as high as 60%. Endoscopic Ultrasound (EUS)-guided Entero-Colostomy, is an emerging alternative for palliative management of MSBO when other surgical or endoscopic interventions are not feasible or fail.

Case Description/Methods: We present a case of a 50-year-old female with poorly differentiated squamous cell carcinoma of the cervix and carcinomatosis of the peritoneum who underwent 6 cycles of chemotherapy and radiation followed by 4 doses of brachytherapy two years before this presentation. She presented to the ED with complaints of intractable nausea, vomiting, and abdominal pain. On CTAP, she was found to have small bowel obstruction, and she underwent a diagnostic laparoscopy, lysis of adhesions, and biopsy of peritoneal implants and mesenteric nodules. Pathology reports of the same showed metastatic keratinizing squamous cell carcinoma. Her symptoms recurred after 2 months, and a small bowel obstruction was found on a CTAP with IV contrast with transition points in the terminal ileum. Considering dilated small bowel loops adjacent to the descending colon on imaging, and the poor candidate for a repeat laparoscopy, she was planned for an enterocolostomy. A significant sigmoid colon stenosis was present during colonoscopy, which restricted our approach for enterocolostomy; hence, a 25mm X 6mm WallFlex stent was placed under fluoroscopic guidance in the sigmoid colon. After 7 days of the first colonoscopy, an Axios stent was deployed between the distal descending colon and likely mid-jejunum via EUS guidance and under fluoroscopic guidance followed by placement of hemostatic clips. Her diet was advanced and she was ultimately discharged 3 days after the procedure on a low-residue diet. Unfortunately, the patient passed away 4 months after the procedure from sepsis.

Discussion: This case highlights the evolving role of EUS-guided interventions like enterocolostomy in the palliative management of MSBO when traditional surgical interventions or other endoscopic approaches fail or are deemed unfit due to advanced malignancy, poor surgical candidacy, or anatomic factors.



Disclosures:


Ritik M. Goyal, MBBS¹, Shivani Patel, MD¹, Mohamed Ismail, DO¹, Imran A. Qureshi, MD¹, Wajiha Khan, MD², Anand Shah, MD¹, Ahmed Al-Khazraji, MD¹, Kaveh Hajifathalian, MD¹. P1092 - Colonic Stenting and EUS-Guided EnteroColostomy in Malignant Small Bowel Obstruction: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.