Successful Resolution of Refractory Post-tubercular Ileocecal Stricture by Lumen Apposing Metal Stent

Abstract

Tuberculosis is one of the common causes of benign small bowel obstruction and endoscopic management mainly relies on serial balloon dilatation. In this report, we describe a 35 year male with refractory post-tubercular ileal stricture that was successfully treated with a lumen apposing metal stent

Keywords

colonoscopy - LAMS - tuberculosis

A 35-year-old male presented with recurrent episodes of colicky abdominal pain. He was treated with antitubercular therapy (ATT) 6 months ago for ileocecal tuberculosis. Colonoscopy was done after completion of ATT revealed narrowed ileocecal opening and patient underwent endoscopic balloon dilatation (EBD) of the residual stricture elsewhere. Postdilatation patient had improvement in abdominal pain but symptoms recurred 3 weeks post-EBD. Despite four sessions of EBD, patient's symptoms continued to relapse and patient was referred to us for further management. Colonoscopy revealed non-negotiable narrowing of the ileocecal opening ([Fig. 1A]). The colonoscope was exchanged with a double-channel gastroscope and the narrowed ileocecal area cannulated with a cannula. Contrast injection revealed a short-segment stricture ([Fig. 1B]) involving the terminal ileum. After securing guide wire in the terminal ileum, a lumen apposing metal stent (LAMS) (Plumber Stent; mm diameter, 4-cm total length; flare 28 mm and diameter 16 mm; MI Tech Gyeonggi-Do, 17706, Korea) was placed across the narrowing ([Fig. 2]). The symptoms improved following the stent placement and patient did not have recurrence of the abdominal pain. The stent was removed 6 weeks later and colonoscopy revealed resolution of the stricture with the scope being negotiable into the terminal ileum. Following the stent removal, patient remains asymptomatic.

Fig. 1 (A) Colonoscopy: non-negotiable narrowing of the ileocecal opening. (B) Short-segment stricture involving the terminal ileum.

Fig. 2 Lumen apposing metal stent placed across the narrowing.

Tuberculosis is one of the common causes of benign small bowel obstruction and endoscopic management mainly relies on serial balloon dilatation.[1] Surgery is the only alternative for patients not responding to endoscopic dilatation. Recently, LAMS has been used for treatment of refractory Crohn's disease bowel stricture, and it seems to be a promising management option for refractory post-tubercular stricture.[2]

Conflict of Interest

None declared.

Author Contribution

S.S.R.: drafting of manuscript and collection of data.

R.G.: collection of data.

• References

• 1 Singh Rana S, Kumar Bhasin D, Rao C, Singh K. Tubercular versus Crohn's ileal strictures: role of endoscopic balloon dilatation without fluoroscopy. Ann Gastroenterol 2013; 26 (02) 141-145
• 2 Axelrad JE, Lichtiger S, Sethi A. Treatment of Crohn's disease anastomotic stricture with a lumen-apposing metal stent. Clin Gastroenterol Hepatol 2018; 16 (03) A25-A26

Publication History

Article published online:
13 September 2022