Subscribe to RSS
Download PDF
DOI: 10.1055/a-2234-4462
Stent with vacuum therapy for treatment of colonic anastomotic leakage
A 64-year-old patient with a history of severe biliary pancreatitis complicated by partial small-bowel resection and extensive adhesiolysis, and a sigmoid resection with colostomy formation due to diverticulitis, presented with an anastomotic leak and intra-abdominal collections after colostomy reversal ([Fig. 1]). This case presented a challenge as there was no possibility of surgical correction, and thus, any endoscopic option would have to contend with ongoing fecal flow.
An over-the-scope clip was considered but the luminal diameter was too narrow to allow adequate positioning of the device. An Endo-SPONGE (B. Braun, Meslungen, Germany) was considered but rejected due to the inability to deviate the fecal flow. A colonic stent would provide defect cover but has a high risk of migration and would not stimulate wound healing. A VacStent GI (VacStent Medtech AG, Steinhausen, Switzerland) is a fully covered self-expanding metal stent covered with a sponge, which enables both sealing of the defect as well as local vacuum therapy, and given these characteristics it was decided to use the VacStent to achieve defect closure ([Video 1]).
Successful treatment of anastomotic defect with VacStent (VacStent Medtech AG, Steinhausen, Switzerland).Video 1The VacStent was developed to treat esophageal perforations and upper gastrointestinal anastomotic leakage but, to our best knowledge, has never been used in the colon. After 7 days of VacStent application, full defect closure was achieved while the patient continued to have daily bowel motions ([Fig. 2]). This opens up an exciting novel endoscopic treatment option for colonic anastomotic defects and offers potentially significant advantages compared with existing endoscopic options, as it provides both defect closure as well as vacuum therapy, while allowing uninterrupted fecal flow and obviating the need for a temporary diverting colostomy.
Endoscopy_UCTN_Code_TTT_1AQ_2AG
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.
Conflict of Interest
The authors declare that they have no conflict of interest.
Correspondence
Publication History
Article published online:
02 February 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany