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 [1] [2] [3] [4]. 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 0.5 cm in length was confirmed under colonoscopy and meglumine diatrizoate radiography ([Fig. 1]).

Fig. 1 Rectal anastomotic atresia 0.5 cm in length: a colonoscopy, b meglumine diatrizoate radiography.

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]).

Fig. 2 Endoscopy-assisted rectal magnetic compression anastomosis and balloon dilatation. a, b Magnetic rings in place: a on the oral side, b on the anal side. c C-arm radiography shows the magnetic rings to be well-aligned. d Balloon dilation. e, f Anastomotic stoma after dilation.

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]).

Fig. 3 Re-formed atresic rectal anastomotic stoma, treated by repeat magnetic compression anastomosis and balloon dilatation followed by stent implantation. a Atresic anastomotic stoma. b, c Magnetic rings in place: b on the oral side, c on the anal side. d Anastomotic stoma stenosis. e Balloon dilation. f Stent implantation.

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]).

Fig. 4 a – c Recanalized anastomotic stoma. d Patient’s abdomen after stoma closure surgery.

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• References

• 1 Jiang XM, Yamamoto K, Tsuchiya T. et al. Magnetic compression anastomosis for biliary obstruction after partial hepatectomy. Endoscopy 2018; 50: E144-E145
• 2 Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27: 239-249
• 3 Mimuro A, Tsuchida A, Yamanouchi E. et al. A novel technique of magnetic compression anastomosis for severe biliary stenosis. Gastrointest Endosc 2003; 58: 283-287
• 4 Jang SI, Rhee K, Kim H. et al. Recanalization of refractory benign biliary stricture using magnetic compression anastomosis. Endoscopy 2014; 46: 70-74