Recanalization of a complete coloanal anastomotic obstruction using a combined antegrade-retrograde rendezvous technique
A 66-year-old man with a history of lower rectal adenocarcinoma and robotic-assisted low anterior resection with creation of a diverting ileostomy, presented with complete stenosis of the coloanal anastomosis ([Fig. 1 a]). Rendezvous recanalization of the coloanal obstruction was planned ([Video 1]).
Video 1 Recanalization of a complete coloanal anastomotic obstruction using a combined antegrade-retrograde rendezvous technique.
A pediatric colonoscope was advanced through the ileostomy toward the distal colon where complete obstruction was identified at the coloanal anastomosis ([Fig. 1 b]). As the colonoscope could not be advanced to the blind end, the blunt end of an injection needle was used to push at the blind end to facilitate identification of the puncture site ([Fig. 2 a]). Using transillumination and digital palpation, the coloanal anastomosis was punctured from the anal side using a trocar ([Fig. 2 b]). A 0.035-inch Jagwire (Boston Scientific, Marlborough, Massachusetts, USA) was advanced through the trocar and captured using a snare. The guidewire was pulled out and both ends of the guidewire were captured. The coloanal stricture was dilated using a controlled radial expansion balloon ([Fig. 3 a]). An 18 × 153-mm esophageal fully covered metal stent was advanced from the anal side and deployed across the coloanal stricture ([Fig. 3 b]). The stent was secured with two 2-0 silk sutures. To maintain patency of the anastomosis in the event of stent migration, a colonic decompression tube was advanced over the guidewire and both ends were sutured together. Computed tomography scan confirmed correct position of the stent ([Fig. 4]).
Sigmoidoscopy was performed at 4 weeks for stent removal. The anastomosis was patent and had healed ([Fig. 5]). Ileostomy reversal was successfully performed 5 days later.
Rendezvous recanalization of complete coloanal obstruction is a potential alternative to revision surgery, which is difficult and has high morbidity. When endoscopic ultrasound-guided techniques for accessing the proximal colon are not possible, combination of transillumination and digital palpation is a viable option.
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
27 February 2020 (online)
© Georg Thieme Verlag KG
Stuttgart · New York