Endoscopic ultrasonography-guided drainage of a rectal mucocele after total colectomy for Crohn's disease.

A 40-year-old woman was admitted with acute urinary retention and failed towean off the Foley catheter. She had a known history of Crohn’s disease and 5 years previously had undergone total colectomy and end ileostomy as treatment for massive gastrointestinal bleeding due to pancolitis. Computed tomography showed a grossly distended rectal stump up to 15× 9cm in size (●" Fig.1). Sigmoidoscopy showed a blind-ended stump 5cm from the anal verge. The overall features were compatible with a large rectal stump mucocele. The patient was scheduled for endoscopic ultrasound (EUS)-guided transrectal drainage. The rectal mucocele was punctured by a 19-gauge needle (Echo-19; Cook Medical Inc., Bloomington, Indiana, USA) using a curvilinear echoendoscope (GF-UTC 260; Olympus, Tokyo, Japan) introduced via the anus. A 0.025-inch guide wire (Visiglide; Olympus) was inserted and looped around the mucocele (●" Fig.2). The track of the guide wire was dilated to 8mm in size using a controlled radial expansion balloon (Boston Scientific, Natick, Massachusetts, USA). Another guidewirewas inserted into themucocele and two plastic stents were placed (10Fr× 5cm and 7Fr×4cm) (●" Fig.3). There was good drainage of large amounts of clear viscous fluid. Follow-up computed tomography 1 month later showed complete resolution of the mucocele (●" Fig.4). The patient was able to void following the procedure. Rectal mucoceles are a rare entity and occur as a result of distal stenosis in the rectal stump after colectomy and end colostomy [1,2]. They are more commonly seen in patients who have undergone surgery for complications of inflammatory bowel diseases. These mucoceles can grow slowly over a prolonged period and can reach large sizes. They can then exert pressure upon surrounding organs and can compress the bladder and ureter. Traditional treatment involves percutaneous drainage or surgical resection [3]. To our knowledge, the current case is the only report in which EUSwas used for therapy by guiding internal drainage.