When surgery and endoscopic decompressive gastrostomy are not an option: CT-guided transhepatic decompression for malignant bowel obstruction in a patient after esophagectomy with colon interposition.

A malignant bowel obstruction is a challenging complication in advanced gastrointestinal cancers. It can result from the compression by tumor, diffuse carcinomatosis, or adhesions from prior surgeries. Regardless of the underlying cause, malignant bowel obstructions and their associated symptoms are highly distressing and severely impact the quality of life for patients. For those with inoperable tumors and malignant bowel obstruction, decompressive gastrostomy is considered an effective method to relieve symptoms. This procedure can be performed either surgically or percutaneously with endoscopic or fluoroscopic guidance. However, these approaches may be challenging or unfeasible in patients with altered anatomy following surgery or extensive peritoneal carcinomatosis and thus need an interdisciplinary approach. This report details the case of a patient with peritoneal metastasis after an esophagectomy with colon interposition, who presented with recurrent vomiting due to malignant bowel obstruction and a "frozen abdomen", and underwent transhepatic decompression of the colon interposition under CT and endoscopic guidance.