The Temporary Placement of Covered Self-Expandable Metal Stents to Seal Various Gastrointestinal Leaks after Surgery
A 55-year-old man underwent total gastrectomy with lymphnode dissection and end-to-end Roux-en-Y esophagojejunostomy for advanced gastric cancer. Pneumoperitoneum was observed 8 days after the surgery, and a second operation revealed extensive leakage from the esophagojejunal anastomosis. Only irrigation and drainage could be performed, because a primary closure was impossible due to the friability of the operated tissue. However, most of radiocontrast still leaked out 10 days after the second surgery.\nEndoscopy revealed near-total dehiscence of the anastomosis (). Completely covered SEMS (Niti-S esophageal covered stent, 1.8×6.0 cm; Taewoong Medical Co., Goyang, Korea) was applied. However, the stent migrated distally 2 days after the insertion. Thus, we placed an anti-migration stent with 1.0-cm-wide uncovered proximal flanges and silk threads that linked its upper edge with the patient's earlobe (CHOOSTENT® esophageal ST (CCN), 2.2×12.0 cm; M. I. Tech Co., Ltd.) after removing the migrated stent. Oral feeding was started after 2 weeks, and the drainage from the catheter stopped 4 weeks after the insertion of the stent. A follow-up radiocontrast study revealed no leakage, and the stent was removed 5 weeks after the second stent insertion. Minor bleeding occurred after the removal because the uncovered portion of the proximal flange was embedded in the mucosa. Follow-up endoscopy 10 days after the removal revealed complete healing of the dehiscence and bleeding site (). The patient died 3 months later from the progression of gastric cancer.