PMC5479956_01
A plain abdominal radiograph obtained on re-admission, showing a small amount of intestinal gas in the upper abdomen.
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A plain radiograph of the abdomen showed niveau formation in the small intestine (Fig. 1).
Contrast-enhanced abdominal computed tomographic scans of the abdomen obtained on re-admission, showing contrast enhancement and thickening of the intestinal wall at the anastomosis (yellow arrow) and stenosis of the anastomotic lumen. There was no evidence of findings such as abscess formation or mesenteric panniculitis around the anastomosis.. A: Axial section, B: Sagittal section.
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There was no evidence of abscess formation, suture failure, internal hernia, or strangulated bowel obstruction (Fig. 2).
Contrast-enhanced computed tomographic scans of the abdomen obtained on the fourth day after re-admission, showing that the intestinal wall at the anastomosis (yellow arrow) and the surrounding region were unchanged, as compared with the status at the time of re-admission. However, dilatation of the colon proximal to the anastomosis had markedly worsened.. A: Axial section, B: Sagittal section.
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CT on the fourth hospital day showed that dilatation of the colon proximal to the anastomosis had further worsened (Fig. 3).
Lower gastrointestinal endoscopy on the sixth day after re-admission showed an edematous circumferential stricture of the anastomosis. There was no irregularity of the mucosal surface.
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Lower gastrointestinal endoscopy was therefore performed on the sixth hospital day (postoperative day 17, Fig. 4).
(A) Colonography performed with Gastrografin on the sixth day after re-admission showed an anastomotic stricture (yellow arrow) and dilatation of the proximal colon. (B) A transanal ileus tube was placed in the intestine proximal to the anastomosis. (C) Colonography on the 10th day after re-admission showed that the anastomotic stricture (yellow arrow) and dilated proximal colon had improved slightly. However, contrast media infused proximally to the anastomosis poorly flowed to the distal intestine. (D) Colonography on the 14th day after re-admission showed that the anastomotic stricture (yellow arrow) had further improved, and contrast media infused proximally to the anastomosis smoothly flowed distally.
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Therefore, after obtaining fully informed consent from the patient, the anastomotic stricture was treated by intralesional steroid injection (Ile-SI) (4 mg of betamethasone plus 9 mL of physiological saline solution; total volume, 10 mL), and a transanal decompression tube was placed in the colon proximal to the anastomosis (Fig. 5A and B). Colonography performed via the transanal decompression tube showed that the anastomotic stricture had further improved, and the transanal decompression tube was removed on the 14th hospital day (Fig. 5C and D).
Lower gastrointestinal endoscopy performed 5 months after surgery showed no anastomotic stricture (yellow arrow). A fiberscope passed smoothly through the site.
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The patient recovered uneventfully (Fig. 6).