There are several reasons for failure in the insertion of a
self-expandable metallic stent(SEMS)into a malignant colonic obstruction(
MCO)including difficulty in insertion of the
catheter or guidewire through the stenotic lumen into the oral side or perforation relatedto the technique. Herein, we report a case of
MCO bearing another synchronous obstructive lesion in the anal side of the colon that couldhave explainedthe difficulty in the insertion of the SEMS into the
stenosis locatedin the oral side, which might have indicated the need for an emergency operation for relieving the obstruction. A 76-year-oldman with epigastralgia andmelena was admittedto our hospital andhe was diagnosedwith a
MCO in the ascending colon. A series of examinations performedafter admission revealedthat the patient hadanother synchronous obstructive lesion in the descending colon, which made
colonoscope insertion at the oral side difficult. The next day after admission, we observed that fasting relievedthe patient from
abdominal pain causedby obstruction; therefore, we performedSEMS insertion into the
MCO of the descending colon followed by SEMS insertion into the ascending colon after 6 days. These serial SEMS insertions facilitated the
oral administration of the diet and the patient was discharged 15 days after admission. The patient was readmittedto our hospital andhe underwent a radical operation for both lesions in June 2015.