Endoscopic septotomy for a rare colorectal anastomotic complication after elective laparoscopic sigmoidectomy for diverticular disease
Mario Gagliardi, Carmela Abbatiello, Mariano Sica, Carlo Soldaini, Michele Fusco, Attilio Maurano, Claudio Zulli
Abstract
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TopicsDiverticular Disease and Complications · Colorectal Cancer Surgical Treatments · Gastric Cancer Management and Outcomes
A 55-year-old woman who complained of colicky pain, constipation, and abdominal fullness was referred to our endoscopy center by the surgical unit. The patient had undergone elective sigmoidectomy for diverticular disease 5 weeks previously and had received 1 week of polyethylene glycol (PEG)-based laxatives and antispasmodic therapy without clinical improvement.
As a colorectal anastomotic stricture was suspected, rectoscopy was scheduled and performed, showing a thick septum that was partially occluding the colorectal anastomosis, which appeared to be freely passable with a gastroscope ( Fig. 1 a ). During the same procedure, an endoscopic septotomy was performed using a single-use Triangle Tip electrosurgical knife ( Fig. 1 b ). A minimal amount of intraprocedural bleeding occurred and was treated by the application of through-the-scope clips ( Fig. 2 ). No other complications were observed ( Video 1 ).
Rectoscopic views showing: a a thick septum that was partially occluding the colorectal anastomosis; b endoscopic septotomy being performed with a single-use Triangle Tip electrosurgical knife.
The efficacy of endoscopic septotomy is shown in comparable images: a pre-procedure; b 4 weeks after the treatment.
Endoscopic septotomy is performed for a rare colorectal anastomotic complication after elective laparoscopic sigmoidectomy for diverticular disease.Video 1
The patient returned 4 weeks later to undergo a follow-up rectoscopy, which showed the septotomy scarring and a wide anastomotic lumen. No bleeding, tenesmus, or constipation were reported by the patient over the next weeks.
Anastomotic stricture/stenosis is a common complication after colorectal anastomosis 1 but, to the best of our knowledge, we here report for the first time endoscopic septotomy for the treatment of a colorectal anastomotic septum. This treatment may become a valid alternative to revisional surgery for this rare colorectal anastomotic complication after elective laparoscopic sigmoidectomy.
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