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Endoscopy-assisted magnetic compression anastomosis for rectal anastomotic atresia
Magnetic compression anastomosis (MCA) has been used to achieve anastomotic recanalization to treat severe stenosis or atresia of the biliary tract and digestive tract    . Herein, we report successful recanalization by means of MCA in a case of rectal anastomotic atresia.
A 60-year-old man who had undergone radical resection combined with double-lumen ileostomies for rectal carcinoma 1 year ago, and was scheduled to undergo stoma closure surgery 3 months ago, was admitted to our hospital with anastomotic atresia, where the anastomosis was completely obstructed by regenerated scar tissue. Anastomotic atresia 5 cm in length was confirmed under colonoscopy and meglumine diatrizoate radiography ([Fig. 1]).
After the patient had given signed informed consent and undergone preoperative examination and general anesthesia, endoscopy-assisted rectal MCA was performed, lasting 1.5 h ([Fig. 2]). The enteroscope with the magnetic ring attached to it was passed in a retrograde manner from the terminal ileum to the blind end of the anastomotic stoma, where the magnetic ring was released. Then another magnetic ring was passed by hand through the anus to the anastomosis. The two magnetic rings were attracted to each other across the anastomotic stoma. Lastly, the enteroscope was removed and C-arm radiography showed that the magnetic rings were well aligned. At 13 days after MCA, the magnetic ring complex was discharged through the anus. Anastomotic stoma recanalization with an intestinal diameter enlarged to 1 cm after balloon dilatation was confirmed by colonoscopy ([Fig. 2]).
After 1 month, the rectal anastomotic stoma was atresic again, and endoscopy-assisted rectal MCA was again carried out; repeat anastomotic balloon dilation with subsequent stent implantation were then performed ([Fig. 3]; [Video 1]).
Video 1 Endoscopy-assisted rectal magnetic compression anastomosis.
Anastomotic stoma recanalization was confirmed by colonoscopy without resistance 7 months after the operation. Stoma-closure surgery has been performed, and normal transanal defecation has been restored ([Fig. 4]).
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* Jing Li and Guifang Lu contributed equally to this article and are considered joint first authors.
27 January 2021 (online)
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