Title : EUS-guided colo-enteric anastomosis for complete malignant large bowel obstruction in a frail elderly patient: A rare minimally invasive salvage procedure
Abstract:
Background: Complete malignant large bowel obstruction in frail elderly patients presents a major therapeutic challenge when conventional colonic stenting fails and surgery carries prohibitive risk. We report a rare case in which advanced endoscopic intervention was used as a life-saving salvage strategy.
Case Presentation: An 81-year-old male presented to the emergency department with acute colonic obstruction. Evaluation revealed sigmoid colon carcinoma with liver metastases, complicated by sepsis, Acute Kidney Injury (AKI), and respiratory failure. Conventional colonic Self-Expanding Metallic Stent (SEMS) placement was attempted but failed due to a complete, angulated obstruction that precluded the passage of contrast. Given the patient’s severe frailty and poor anesthetic tolerance, surgical diversion (laparotomy and colostomy) was deemed high-risk. Consequently, an EUS-guided colo-enteric anastomosis was performed between the sigmoid colon and ileum using a Hot AXIOS Lumen-Apposing Metal Stent (LAMS) to bypass the obstruction.
Results: The procedure was technically successful and performed under Monitored Anesthesia Care (MAC) rather than general anesthesia. It was well-tolerated with no intraprocedural blood loss. Post-procedure clinical recovery was rapid; the patient experienced significant symptomatic relief within hours, resumed oral intake, and was discharged within a few days.
Conclusion & Significance: EUS-guided colo-enteric anastomosis can be a lifesaving minimally invasive salvage option in selected high-risk patients with complete malignant large bowel obstruction when both standard endoscopic stenting and surgery are not feasible. This case highlights the expanding role of advanced therapeutic endoscopy in delivering effective, patient-centered care to frail individuals who cannot tolerate conventional operative intervention.
