Following fluid resuscitation, plain abdominal radiographs with subsequent single contrast enema were obtained (Fig. 1). These demonstrated distal descending colon obstruction with the classic apple core shouldered appearance of a malignant stricture.
Following these studies a 22mm, 12cm enteral stent was placed under fluoroscopic guidance alone across the stricture with relief of symptoms. Subsequently the patient had an elective primary anastomosis following staging investigations prior to surgery.
Placement of a colonic stent to relieve the obstruction from a malignant stricture allows adequate preoperative staging or palliation of symptoms if the patient is considered unsuitable for surgery. If elective surgery is undertaken following stent placement, this is on a prepared bowel, increasing the likelihood of successful primary anastomosis and hence avoiding colostomy.
Stent placement can be by either both endoscopic and fluoroscopic guidance or fluoroscopic guidance alone, both approaches having a technical success rate (stent deployed across stricture) of approximately 90% and a clinical success rate (relief of obstruction) of 75-90%. Potential significant complications of stent placement are perforation (<16%), tumour ingrowth to the stent (25%), and stent migration (15-20%).
 Camunez F, Echenagusia A, Simo G, Turegano F, Vazquez J, Barreiro-Meiro I.
Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation.
Radiology 2000 Aug;216(2):492-7.
 Miyayama S, Matsui O, Kifune K, Yamashiro M, Yamamoto T, Kitagawa K, Kasahara Y, Asada Y, Iida Y, Miura S.
Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent.
AJR Am J Roentgenol 2000 Dec;175(6):1631-7.
 Mauro MA, Koehler RE, Baron TH.
Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents.
Radiology 2000 Jun;215(3):659-69.
 de Gregorio MA, Mainar A, Tejero E, Tobio R, Alfonso E, Pinto I, Fernandez R, Herrera M, Fernandez JA.
Acute colorectal obstruction: stent placement for palliative treatment --results of a multicenter study.
Radiology 1998 Oct;209(1):117-20.