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Endoscopic management of acute colorectal anastomotic complications with temporary stent.

Abbas MA - JSLS (2009 Jul-Sep)

Bottom Line: Acute postoperative anastomotic complications following colorectal resection include leak and obstruction.The role of endoluminal procedures to treat these complications has been limited.This article illustrates that such an approach is technically feasible and can be used to treat some colorectal anastomotic complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, California 90027, USA. maher.a.abbas@kp.org

ABSTRACT
Acute postoperative anastomotic complications following colorectal resection include leak and obstruction. Often an operation is necessary to treat these complications. The role of endoluminal procedures to treat these complications has been limited. This article illustrates that such an approach is technically feasible and can be used to treat some colorectal anastomotic complications.

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Polyflex stent with Triclip clip fixation in patient #2.
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Figure 6: Polyflex stent with Triclip clip fixation in patient #2.

Mentions: Patient 2 had spontaneous decompression of her obstruction the day of her procedure but 2 days later redeveloped obstructive symptoms. Repeat endoscopy revealed migration of the stent into the distal rectum. Repeat stenting was performed, and the distal aspect of the new stent was clipped to the rectal mucosa by using 4 Resolution clips (Boston Scientific, Natick, Maryland) to minimize migration. The patient's condition improved, and she was started on a liquid diet; however, 10 days following her second stent, her symptoms recurred. Repeat endoscopy showed migration of the stent. Stenting was repeated, and the distal aspect of the stent was secured to the rectum by using TriClip clips (Wilson-Cook Medical, Winston-Salem, North Carolina) (Figure 6). The obstructive symptoms resolved, and the patient was started on a liquid diet that was advanced to a regular diet. She was discharged from the hospital on postoperative day 28. Except for a urinary tract infection treated on an outpatient basis, she had a full recovery. One month after discharge, the Polyflex stent was removed in the endoscopy suite. Repeat endoscopy 3 months later demonstrated a patent and healed anastomosis without evidence of stricture (Figure 7). She remains well and free of obstructive symptoms 6 months following her hospitalization.


Endoscopic management of acute colorectal anastomotic complications with temporary stent.

Abbas MA - JSLS (2009 Jul-Sep)

Polyflex stent with Triclip clip fixation in patient #2.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3015959&req=5

Figure 6: Polyflex stent with Triclip clip fixation in patient #2.
Mentions: Patient 2 had spontaneous decompression of her obstruction the day of her procedure but 2 days later redeveloped obstructive symptoms. Repeat endoscopy revealed migration of the stent into the distal rectum. Repeat stenting was performed, and the distal aspect of the new stent was clipped to the rectal mucosa by using 4 Resolution clips (Boston Scientific, Natick, Maryland) to minimize migration. The patient's condition improved, and she was started on a liquid diet; however, 10 days following her second stent, her symptoms recurred. Repeat endoscopy showed migration of the stent. Stenting was repeated, and the distal aspect of the stent was secured to the rectum by using TriClip clips (Wilson-Cook Medical, Winston-Salem, North Carolina) (Figure 6). The obstructive symptoms resolved, and the patient was started on a liquid diet that was advanced to a regular diet. She was discharged from the hospital on postoperative day 28. Except for a urinary tract infection treated on an outpatient basis, she had a full recovery. One month after discharge, the Polyflex stent was removed in the endoscopy suite. Repeat endoscopy 3 months later demonstrated a patent and healed anastomosis without evidence of stricture (Figure 7). She remains well and free of obstructive symptoms 6 months following her hospitalization.

Bottom Line: Acute postoperative anastomotic complications following colorectal resection include leak and obstruction.The role of endoluminal procedures to treat these complications has been limited.This article illustrates that such an approach is technically feasible and can be used to treat some colorectal anastomotic complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kaiser Permanente, Los Angeles, California 90027, USA. maher.a.abbas@kp.org

ABSTRACT
Acute postoperative anastomotic complications following colorectal resection include leak and obstruction. Often an operation is necessary to treat these complications. The role of endoluminal procedures to treat these complications has been limited. This article illustrates that such an approach is technically feasible and can be used to treat some colorectal anastomotic complications.

Show MeSH
Related in: MedlinePlus