A 70-year-old woman was admitted with rectal pain and soiling 3 years after a Longo’s
stapled hemorrhoidopexy [1]. Physical examination and laboratory tests were negative. Colonoscopy showed a 30-mm
bulge with a 3-mm orifice in the lower rectum. Stools could be observed through the
orifice ([Fig. 1]). A pelvic magnetic resonance imaging scan highlighted a stool-laden diverticulum
of the mesorectal region, 35 × 20 × 25 mm in size ([Fig. 2]). An endoscopic ultrasound color-Doppler examination showed poor vascularization
of the septum between the diverticulum and the rectal lumen.
Fig. 1 Rectal bulge with central orifice.
Fig. 2 Pelvic magnetic resonance imaging showed a stool-laden diverticulum in the mesorectal
region.
Endoscopic incision of the cavity wall was performed using a biliary pre-cut needle,
with incisions at 3, 6, and 9 o'clock ([Fig. 3]). Stools were then evacuated by digital squeezing. The procedure was complicated
by bleeding, which was successfully treated by endoscopic clipping.
Fig. 3 Endoscopic incision of the cavity.
The patient was discharged after a brief observation period. At 1-month follow-up
she was asymptomatic, and lower endoscopy showed a fully opened diverticulum with
no residual stool ([Fig. 4]).
Fig. 4 The fully opened diverticulum (1 month follow-up).
The “rectal pocket syndrome,” caused by entrapment of the tied purse string by fired
staples, is a rare complication (2.5 %) of stapled hemorrhoidopexy and usually requires
surgical opening of the pocket [2]. Only two case reports have been published previously in the literature, one of
which was managed by releasing the tied suture and the other by creating a diverting
stoma [3]
[4]. To our knowledge the present case is the first report of endoscopic treatment for
rectal pocket syndrome. The procedure appears to be feasible, safe, and effective.
The idea was taken from experience of treatment of esophageal rings by means of sagittal
incision [5].
Endoscopy_UCTN_Code_TTT_1AQ_2AJ
