PMC6535867_01
(a) Colonoscopy showed severe anastomotic stenosis 4 months after surgery. (b) When the balloon was expanded by injecting a contrast agent, localized stenosis was shown (yellow arrow). (c) Mucosal injury occurred during the fourth endoscopic balloon dilation therapy. The passage of colonoscope has become possible.
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fig1
The colonoscopy revealed severe stenosis at 15 cm from the anal verge (Figure 1(a)). Endoscopic balloon dilation was performed several times (Figure 1(b)), allowing the passage of loose stool. Mucosal injury occurred during the last dilation (Figure 1(c)), making further balloon dilation difficult.
Colonoscopy showed restenosis of the anastomotic site 5 months after balloon dilation. It seemed that endoscopic colonic decompression could not be done.
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The colonoscopy revealed the complete obstruction of the anastomotic site (Figure 2).
(a) A pin hole was made with a biopsy forceps at anastomotic stenosis. The biopsy forceps was passed through the stenosis. (b) Silk thread was passed as a guide tool from the stoma to the anus. (c) By pulling the silk thread tied to the suture hole of the anvil, the anvil central rod was passed through the stenosis as a bougie. (d) The instrument body was inserted transanally, and the central shaft was passed through the hole of stenosis made with the mechanical bougie. (e) Looking inside the stoma, the anvil center rod was manually attached to the central shaft under direct viewing. (f) After EEA firing, the colonoscopy showed that stenosis was resected successfully.
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fig3
The colonoscopy was transanally inserted until the stenosis (Figure 3(a)). Using no. 0 silk thread, the biopsy forceps was passed through the stenosis and was guided to the anus (Figure 3(b)). Subsequently, the anvil was inserted from the anus, and similarly, the anvil central rod was passed in the direction of the stoma as a bougie (Figure 3(c)). The instrument body was inserted transanally, and the central shaft was passed through the hole created with mechanical bougie by the anvil central rod (Figure 3(d)). The anvil was inserted from the stoma, and the anvil central rod was manually attached to the central shaft (Figure 3(e)). After resection, the colonoscopy confirmed that the procedure was successful (Figure 3(f)).
Colonoscopy showed no restenosis 1 month after resection of anastomotic stenosis.
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The colonoscopy showed no restenosis 1 month after surgery (Figure 4), and the patient could undergo stoma closure.