Blind Loop Syndrome at the Functional End-to-end Anastomotic Site of the Ileum—A Case Report—

Abstract

A 70-year-old man was admitted to a hospital with sustained pain in the hypogastric region of his abdomen. He had a history of left nephroureterectomy for bladder cancer at 46 years of age and total cystectomy and ileal neobladder reconstruction for recurrence of the cancer at 54 years of age. Abdominal computed tomography revealed a sac-like dilatation of the functional end-to-end anastomotic site of the ileum, containing stagnant intestinal contents. The patient was diagnosed with blind loop syndrome, specifically categorized as the blind pouch type. Abdominal pain persisted, and an urgent operation was performed 3 days after admission, owing to the high risk of intestinal perforation. Although the dilated anastomotic region was not perforated, the anastomotic site was resected and reconstructed by layer-tolayer anastomosis. To date, no recurrence has been observed. Blind loop syndrome of the functional end-to-end anastomotic site is rare. This condition should be considered a possible complication of functional end-to-end intestinal anastomosis, and surgical treatment is necessary in patients presenting with abdominal symptoms.

Blind Pouch Syndrome-Associated Enterolithiasis Successfully Treated with Colonoscopy

“…To date, gastrointestinal series and CT [2, 3] have been reported as useful modalities for the diagnosis of blind pouch syndrome at functional end-to-end anastomosis sites. Recently, coronal reformatted multidetector CT has been shown to aid in detecting a blind pouch by revealing a dilated tract or surgical suture [6, 7, 10]. In the present case, CS clearly revealed enterolithiasis, an anastomotic ulcer, a blind pouch associated with functional end-to-end anastomosis, and a Gastrografin enema examination through CS and multidetector CT revealed enterolithiasis and a blind pouch associated with functional end-to-end anastomosis.…”

“…Blind pouch formation at functional end-to-end anastomosis sites has been reported to be due to the incision of the circular muscle involved in peristalsis, lack of peristalsis at the anastomosis, and dissonance of peristalsis between the anastomosed intestines [7]. However, the mechanism of onset of blind pouch syndrome associated with functional end-to-end anastomosis remains still unknown.…”

“…Blind pouch syndrome is defined as a series of symptoms such as anemia, intermittent abdominal pain, diarrhea, and weight loss, all of which are associated with the formation of a blind pouch secondary to an intestinal anastomosis [1]. Most cases of blind pouch syndrome were shown to be secondary to side-to-side or side-to-end anastomosis, but recently cases of blind pouch have been reported as occurring secondary to functional end-to-end anastomosis [2-7]. Enterolithiasis associated with blind pouch syndrome secondary to functional end-to-end anastomosis is rare and its endoscopic and radiological features remain poorly described.…”