Successful endoscopic treatment of fecalith blocking sinus in a patient with ileal pouch-anal anastomosis

Journal of Coloproctology - Tập 34 - Trang 181-184 - 2014
Jessica Ma1, Brook Zhang1, Xian-rui Wu2, Bo Shen1
1Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, USA
2Department of Colorectal Surgery; The Cleveland Clinic Foundation; Cleveland USA

Tóm tắt

Abstract Background Ulcerative colitis patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis can develop various mechanical complications. Among them is presacral sinus resulting from chronic anastomotic leak. Methods We present a symptomatic patient with a large fecalith blocking the sinus which was successfully treated with Doppler ultrasound guided endoscopic needle knife sinusotomy along with fecalith extraction. Results A 67-year-old female presented with a 4-month history of perianal pain and urgency. Pouchocopy showed a 3-cm deep wide-mouthed anastomotic sinus, the orifice of which was blocked by a large hard fecalith. Removal of the fecalith using RothNet, Tripod, or Basket were made but failed. Then needle knife was applied to cut the orifice to enlarge the opening of the sinus. One month later, the patient returned and the fecalith was successfully removed with two Baskets and two Rothnets. Six months after fecalith extraction, pouchoscopy showed a compartalized distal pouch sinus with two cavities, which was treated by two sessions of Doppler ultrasound guided endoscopic needle knife sinusotomy. Six months following the treatment, the sinus was completed healed. The patient tolerated all procedures well without any complication. Conclusion Fecalith blocking pouch anastomotic sinus is a rare complication in patients with restorative proctocolectomy. In our case, this surgical complication was successfully treated with a carefully planned, stepwise endoscopy approach.

Tài liệu tham khảo

Wu, 2013, Endoscopic needle-knife therapy for ileal pouch sinus: a novel approach for the surgical adverse event (with video), Gastrointest Endosc, 78, 875, 10.1016/j.gie.2013.05.021 Lian, 2009, Endoscopic treatment for pill bezoars after continent ileostomy, Dig Liver Dis, 41, e26, 10.1016/j.dld.2008.02.004 Mmeje, 2010, Image of the month. Pharmacobezoar: a rare complication after ileal pouch-anal anastomosis for ulcerative colitis, Clin Gastroenterol Hepatol, 8, A28, 10.1016/j.cgh.2009.09.034 Ahmed Ali, 2012, The management of anastomotic pouch sinus after IPAA, Dis Colon Rectum, 55, 541, 10.1097/DCR.0b013e318244087c Akbari, 2009, Anastomotic sinuses after ileoanal pouch construction: incidence, management, and outcome, Dis Colon Rectum, 52, 452, 10.1007/DCR.0b013e31819a20e0 Goligher, 1984, Impaction of plastic emptying tube in reservoir of continent ileostomy, Br J Surg, 71, 734, 10.1002/bjs.1800710934
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Thông tin xuất bản

Journal of Coloproctology

Tập 34

181-184

Thông tin tác giả