Ultraschall Med 2005; 26 - OP194
DOI: 10.1055/s-2005-917475

A NOVEL TECHNIQUE OF ENDOSCOPIC REBORING FOR STENOSED RECTAL ANASTOMOSIS UNDER RADIOLOGY GUIDANCE

AK Venkatasubramaniam 1, L Low 2, A Khursheed 1, K Etherson 1, J Lattimer 2, M Tabaqchali 1
  • 1Colorectal surgery
  • 2Intervention Radiology, University Hospital of North Tees, Stockton, United Kingdom

Purpose: Rectal stricture / stenosis are well recognized complications following anterior resection. Completely stenosed rectal anastomoses have been conventionally treated conservatively with permanent stoma. The surgical alternatives are either a redo low resection with its accompanying hazards or formation of a permanent colostomy. We describe a simple method of treating anastomotic stenosis using a novel technique.

Methods and Materials: Patients:

Three patients with complete stenosis of rectal anastomosis following anterior resection underwent this novel technique with informed consent. Stenosis with no identifiable lumen was diagnosed at the time of EUA or by contrast enema.

Methodology:

Water soluble contrast was instilled via the distal loop of the ileostomy to delineate the colon proximal to the stenosed anastomosis. A colonoscope was introduced per rectum under intravenous sedation (pethidine 50mg and midazolam 4mg). With fluoroscopic guidance, a colonoscopic needle was passed at the site where anastomosis was estimated to perforate through the stenosis from below, followed by a guidewire. After confirmation of intraluminal passage of guidewire, the stricture was progressively dilated initially with a 10mm angioplasty balloon followed by a 22mm oesophageal balloon. This enabled the colonoscope to pass through the anastomosis. There were no complications observed following this procedure. Two of the three patients needed repeat endoscopic dilatation. All patients subsequently underwent closure of ileostomy and made an uneventful recovery.

Results: All three patients (who would have otherwise required major surgery)had complete recanalisation of the bowel following dilatation(s) using this technique.

Conclusions: Combined endoscopic dilatation under radiological guidance appears to be simple, safe, effective, and inexpensive method for treating rectal anastomotic stenosis. This novel technique is first of its kind and has not been reported in world literature before.