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Paper text:
self - expandable metal stents ( sems ) are uncommonly used for benign colonic disease because of their lack of removability and their high rate of migration .
histology had confirmed the presence of diverticular disease in the sigmoid colon along with inflammatory changes in the tubes , ovaries and part of the uterus , which was resected en - bloc .
the patient subsequently underwent reversal of her hartmann s procedure with a de - functioning loop ileostomy . at a clinic review two months post hartmann s reversal , the patient complained of intermittent discharge from the lower end of her laparotomy wound associated with per - rectal intermittent discharge of mucous and blood .
contrast studies had revealed the presence of an anastomotic stricture complicated with a colo - cutaneous fistula ( figure 1 ) .
contrast study showing stricture and fistula tract after a discussion with the patient , taking in account her obesity , the agreed plan was to adopt a non - operative approach rather than surgery that may result in a permanent end - colostomy .
three months post hartmann s reversal a balloon dilatation was carried out successfully via flexible sigmoidoscopy as a joint procedure with a specialist radiologist .
four months post hartmann s reversal it was decided to repeat the dilatation then to insert a colonic stent along with percutaneous ethanol injection ( pei ) of the fistula .
this was followed by injection of 20mls of absolute ethanol through the abdominal fistulous tract whilst , at the same time , normal saline was injected into the stent via a foley s catheter to dilute the alcohol within the lumen of the colon .
a month later , contrast studies showed complete resolution of the anastomotic stricture and no evidence of colo - cutaneous fistula ( figure 2 ) .
one year post hartmann s reversal , the patient remained asymptomatic and the fistula had resolved both clinically and radiologically .
follow - up contrast study a year post hartmann s reversal , patient was admitted for reversal of her loop ileostomy , which was performed without complications .
the use of self - expanding metallic stents for benign colorectal diseases has been regarded previously as controversial ( 1,2 ) .
only 3% of stents placed in 567 patients considered in a systematic review in ( 2002 ) were for benign disease , predominantly diverticular disease ( 3 ) .
there has been only a few reports of its use for closure of benign stulae in the colon ( 4 ) . in our case
the presence of a stricture with stulous tracts was an indication for the use of a covered stent for immediate stula closure .
covered sems have a high rate of migration as compared to uncovered sems ( 2,5 ) .
in addition , spontaneous migration of sems for benign strictures occurs frequently , usually within the rst month after insertion ( 6 ) .
ethanol injection for successful ablation of digestive tract fistula has been mentioned in few case reports in the literature ( 7 ) . to our knowledge , this is the rst case demonstrating sems combined with pei for benign postoperative stulae . although longer follow up and future prospective studies are needed ,
we report successful treatment of colocutanteous stulae at the site of a benign colonic anastomotic stricture using self - expandable metal stents ( sems ) and percutaneous ethanol injection ( pei ) . 
 the stricture and the secondary stulae developed after hartmann s procedure for sigmoid diverticular abscess followed by reversal of the hartmann s procedure with a de - functioning loop ileostomy . 
 although there have been previously reported cases of sems for closure of malignant colonic stula , there are limited reports of sems for closure of benign colonic stulae and none of sems combined with pei for benign colonic fistula . we conclude that this patient s case exemplies the potential applications of sems combined with pei as a feasible option of therapy for benign colorectal disease .