A-75-year-old man with rectal adenocarcinoma underwent laparoscopic anterior resection
with the creation of a protective ileostomy.
Endoscopy done 1 month later to assess the possibility of colonic recanalization revealed
a fistula adjacent to the colorectal anastomosis, opening into a 5-cm cavity containing
a large amount of feces and necrotic material.
We were unable to drain the cavity with saline irrigation and suction because of continual
blocking of the endoscopic suction channel with necrotic material and feces. Because
removing this type of waste material with a Roth Net is very time-consuming, we attempted
to apply a new technique to clear the cavity and speed up the procedure.
This drainage procedure was carried out with a high definition endoscope (GIF-H190;
Olympus Medical, Center Valley, Pennsylvania, USA) equipped with a ClearPath cleaning
device (Easy-Glide Ltd., Kfar Truman, Israel) ([Fig. 1]), which allowed rapid saline irrigation and efficient suction of the necrotic material
and feces in the abscess ([Fig. 2], [Video 1]). Procedure time was about 1 minute, and there were no adverse events. The clean
abscess was then successfully treated with vacuum-assisted transanal therapy until
complete closure of the cavity.
Fig. 1 ClearPath device attached to the tip of the scope.
Fig. 2 Use of the cleaning device for saline irrigation and suction of a perianastomotic
colorectal abscess: a before drainage; b after drainage.
Drainage of a perianastomotic colorectal abscess using a ClearPath device.
The ClearPath device was developed for rapid luminal irrigation and efficient aspiration
through its large suction channel, and allows evacuation of fluids, bile, and blood
clots during upper gastrointestinal bleeding while keeping the endoscope working channel
free for insertion of therapeutic devices [1]. Use of a ClearPath device during underwater endoscopic mucosal resection has also
been reported [2].
Endoscopic drainage of feces and necrotic material from an abscess can be difficult
and time-consuming, and possibly entail delay for further therapeutic procedures.
Though this is a single report that will require confirmation, it describes a fast
and simple drainage method, and illustrates a new, useful, and safe application of
this ClearPath device.
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