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Abdominal x ray showed dilated loops of the small bowel with a metal oesophageal stent in the left iliac fossa. The suspicion of stent ileus was confirmed by computed tomography (fig 2) which showed dilated loops of small bowel proximal to the stent. A minilaparotomy was performed which found the small bowel to be dilated down to the site of impaction of the oesophageal stent in the terminal ileum. Unfortunately, the patient developed pneumonia after operation and died three days later.

Stent migration is a recognised complication of oesophageal stenting, occurring in up to 35% of treated patients. It occurs more frequently if the stent is placed across the gastro-oesophageal junction. Provided the patient is asymptomatic, a “wait and see” approach is often reasonable for those with a migrated stent. Indeed, it is not unusual for the migrated stent to be passed spontaneously in stool. Endoscopic retrieval of the stent may be possible if it lies within the stomach. Open surgical removal of the migrated stent is reserved for cases of bowel obstruction or perforation.

Figure 1

 Computed tomography scan of the patient.The small bowel is dilated down to the level of the impacted stent. Thelarge bowel is normal.

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