Endoscopic ultrasonography-guided drainage of a rectal mucocele after total colectomy for Crohn’s disease

A 40-year-old woman was admitted with acute urinary retention and failed to wean off the Foley catheter. She had a known history of Crohn’s disease and 5 years previously had undergone total colectomy and end ileostomy as treatment for massive gastrointestinal bleeding due to pancolitis. Computed tomography showed a grossly distended rectal stump up to 15 × 9 cm in size ([Fig. 1]). Sigmoidoscopy showed a blind-ended stump 5 cm from the anal verge. The overall features were compatible with a large rectal stump mucocele.

Fig. 1 Computed tomography showing a grossly distended rectal stump (arrow head).

The patient was scheduled for endoscopic ultrasound (EUS)-guided transrectal drainage. The rectal mucocele was punctured by a 19-gauge needle (Echo-19; Cook Medical Inc., Bloomington, Indiana, USA) using a curvilinear echoendoscope (GF-UTC 260; Olympus, Tokyo, Japan) introduced via the anus. A 0.025-inch guide wire (Visiglide; Olympus) was inserted and looped around the mucocele ([Fig. 2]). The track of the guide wire was dilated to 8 mm in size using a controlled radial expansion balloon (Boston Scientific, Natick, Massachusetts, USA). Another guide wire was inserted into the mucocele and two plastic stents were placed (10 Fr × 5 cm and 7 Fr × 4 cm) ([Fig. 3]). There was good drainage of large amounts of clear viscous fluid. Follow-up computed tomography 1 month later showed complete resolution of the mucocele ([Fig. 4]). The patient was able to void following the procedure.

Fig. 2 Looping of the guide wire around the rectal mucocele.

Fig. 3 Placement of two plastic stents for drainage of the mucocele.

Fig. 4 Follow-up computed tomography 1 month later showed complete resolution of the mucocele.

Rectal mucoceles are a rare entity and occur as a result of distal stenosis in the rectal stump after colectomy and end colostomy [1] [2]. They are more commonly seen in patients who have undergone surgery for complications of inflammatory bowel diseases. These mucoceles can grow slowly over a prolonged period and can reach large sizes. They can then exert pressure upon surrounding organs and can compress the bladder and ureter. Traditional treatment involves percutaneous drainage or surgical resection [3]. To our knowledge, the current case is the only report in which EUS was used for therapy by guiding internal drainage.

Endoscopy_UCTN_Code_TTT_1AQ_2AJ

Competing interests: None

• References

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• 2 Creagh MF, Chan TYK. Rectal mucocele following Hartmann’s procedure. Clin Radiol 1991; 43: 358-359
• 3 Subhas G, Balaraman S, Mittal VK et al. Extraluminal rectal mucocele resulting from bowel sequestration at the anastomotic site after sigmoidectomy. Am Surg 2010; 76: 107-108