Interventional radiology in palliative care

Two weeks later, the patient began to show symptoms of a bowel obstruction. A spiral CT scan of the abdomen showed a right pelvic mass that was obstructing the sigmoid colon and the distal right ureter, with associated hydronephrosis. A self-expanding metallic colonic stent was inserted by an interventional radiologist using fluoroscopic guidance. Subsequently, a right ureteric double J stent was placed to relieve flank pain caused by pressure from hydronephrosis. The patient's symptoms of bowel obstruction resolved almost immediately following insertion of the colonic stent. However, 1 month later, she experienced another bowel obstruction. A repeat spiral CT scan showed that the colonic stent was in the appropriate position. This time, we felt that the small-bowel obstruction was secondary to the adhesions, and surgical resection with an enteroenteral small-bowel anastomosis was performed. Six minimally invasive interventions were performed to provide palliative care to our patient These types of interventions reflect a partial shift away from open surgical techniques (e.g., abscess drainage, colostomy) to those performed by interventional radiologists. There is increasing evidence that these procedures are safe, effective and result in cost savings compared with open surgical techniques.1 For example, colonie stents have been advocated as a bridge to surgery2 and, more importantly, for the treatment of malignant obstructions in patients receiving palliative care. In the latter case, stenting prevents the need for a colostomy and allows the patient to eat normally (compared to enteral feedings or total patenteral nutrition) and to leave the hospital earlier.3 The success and complication rates of colonic stent placement are within an acceptable range. A systematic pooled analysis that included 54 published reports with a total of 1198 patients found a technical success rate of 94% and a median clinical success rate (relief of obstruction) of 91%.3 Major complications included stent migration (11.8%), recurrent obstruction (7.3%), perforation (3.8%) and death (0.58%).3