Resolution of occult anastomotic stricture with anal dilator: challenges with the conventional diagnostic criteria in low anterior rectal resection patient—a case report

TL;DR

A patient with rectal cancer surgery symptoms was found to have an undiagnosed anastomotic stricture, highlighting the need for better diagnostic criteria.

Contribution

This case report highlights the diagnostic challenges of occult anastomotic strictures and suggests the need for improved diagnostic approaches.

Findings

Conventional diagnostic methods failed to identify anastomotic stricture in a patient with rectal cancer surgery.

Anal dilatation provided symptom relief, suggesting an undiagnosed stricture.

Improved diagnostic criteria considering intestinal diameter and symptoms are needed for accurate diagnosis.

Abstract

Anastomotic stricture (AS) is a common complication following rectal cancer surgery with anastomosis, but its diagnosis and management pose significant challenges due to the lack of standardized diagnostic criteria. We present a case highlighting the complexities encountered in diagnosing and managing occult AS post-rectal cancer surgery.

A 51-year-old male patient presented with symptoms suggestive of AS following robot-assisted laparoscopic low anterior resection for rectal adenocarcinoma. Despite conventional evaluations, including colonoscopy, digital rectal examination, and radiography, AS was not identified. Following prolonged and ineffective treatment for suspected conditions such as low anterior resection syndrome (LARS), the patient underwent anal dilatation, resulting in significant symptom improvement.

This case underscores the challenges associated with diagnosing and managing occult AS following rectal cancer surgery. The absence of standardized diagnostic criteria and reliance on conventional modalities may lead to underdiagnosis and inadequate treatment. A comprehensive diagnostic approach considering intestinal diameter, elasticity, and symptoms related to difficult defecation may enhance diagnostic accuracy. Further research is needed to refine the diagnostic and therapeutic strategies for occult AS.

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