Endoscopic diagnosis and treatment of complete anastomosis stenosis after colorectal resection without protective ileostomy: report of two cases and literature review

Abstract

This case report describes a novel procedure for opening the lumen of a completely obstructed anastomosis when open surgery is not an option. Two patients underwent ileocecal or colorectal resection and one-stage anastomosis reconstruction without diverging ileostomy. The patients developed post-surgical abdominal distension and nausea. Emergency imaging indicated complete anastomotic obstruction and distal intestinal anastomosis emptiness. Colonoscopy revealed an anastomosis that was completely discontinued by a membranous structure. Considering that open surgery was not a viable treatment option, a minimally invasive endoscopic approach was adopted to repair the obstruction. A needle knife was used to puncture the linear white scar and contrast agent was injected under endoscopy and fluoroscopic guidance. Fluoroscopically, the proximal bowel was identified and a dual knife-mediated membrane puncture was performed. A guidewire was then passed through the incision into the proximal bowel and progressive pneumatic dilatation was performed successively with a controlled radial expansion balloon dilator until a 1.8 cm diameter dilation was achieved. After conventional balloon dilatation, the

Clinical Efficacy of Endoscopic Technique in the Treatment of Gastrointestinal Anastomotic Complications: a Retrospective Study

“…Osera et al also concluded that EI is a safe and effective method with low incidence of complications for poor expansion effect or refractory anastomotic stenosis [19]. In our previous research found that for patients with colorectal anastomotic stenosis, endoscopic radial anastomotic incision is a safe and effective treatment method [20]. We think that EI is a safe and effective method, but skilled endoscopic surgeons are required to operate it to prevent the occurrence of serious complications such as perforation and bleeding caused by improper level and depth of incision.…”

The Problem of the Colorectal Anastomosis

“…It can sometimes be treated endoscopically, when surgery is contraindicated, by performing, as was found in a case report by Deng and team [13] with minimally invasive endoscopic approach was adopted to repair the obstruction. A needle knife was used to puncture the linear white scar, and contrast agent was injected under endoscopy and fluoroscopic guidance.…”

Complete stricture following end‐to‐side colorectal anastomosis complicated with acute large bowel obstruction post colostomy closure

“…Hence, it was difficult to predict the timing of the occurrence of an anastomosis stricture post colorectal surgery. Complete colonic anastomotic stenosis obstruction was absolutely rare 1 ; hence, a high index of suspicion was required for prompt intervention. The literature reveals that complete colonic anastomotic stenosis was more common in end‐to‐end anastomosis, but there was no evidence to suggest that any configuration of colorectal anastomosis (side‐to‐side, end‐to‐side, side‐to‐end or end‐to‐end) may have higher tendency of anastomosis stricture 1 .…”

“…2 Several case studies reported that a stricture occurs as early as less than a month. 1 Hence, it was difficult to predict the timing of the occurrence of an anastomosis stricture post colorectal surgery. Complete colonic anastomotic stenosis obstruction was absolutely rare 1 ; hence, a high index of suspicion was required for prompt intervention.…”

“…The literature reveals that complete colonic anastomotic stenosis was more common in end-to-end anastomosis, but there was no evidence to suggest that any configuration of colorectal anastomosis (side-to-side, end-to-side, side-to-end or end-to-end) may have higher tendency of anastomosis stricture. 1 From the literature search, there was no best configuration which may completely prevent stricture. For this case, we identify that the risk of developing a complete stricture despite a normal colonoscopy in 1 year interval.…”