Minimally invasive treatment of benign complete stenosis of colorectal anastomosis.

rectal surgery are leaks and stenosis, which occur with a frequency of 0.3% ± 30 % [1,2]. Strictures are commonly treat− ed with conservative treatments such as balloon dilatation, endoscopic incision, and placement of self−expanding metal stent (SEMS) [3 ± 5]. Two patients with complete colorectal anastomotic closure were successfully treated with an endo− scopic±radiologic rendezvous procedure. A 27−year−old woman who had under− gone low anterior resection due to cancer of the rectum, and a 69−year−old man who had undergone left colonic resection because of acute diverticulitis were re− ferred to our department. Both patients had a loop ileostomy. Endoscopic and radiologic follow−up before recanaliza− tion showed complete anastomotic stric− ture (l" Fig. 1) at 8 cm and 16 cm from the anal verge, respectively. In both pa− tients malignancy was excluded by means of multiple biopsies. Both patients were treated as follows. An incision of the fibrotic stenosis of the anastomosis was made through the rectum using a needle normally used for transjugular intrahepa− tic portosystemic shunt (TIPS). Direct vi− sion of the puncture place was assured by an anterograde colonoscopy from the ileostomy (l" Fig. 2). A guide wire was passed through and a drainage catheter was placed. The drainage catheter was kept in place for 3 days (l" Fig. 3). Follow− ing two balloon dilatations, a fully cov− ered and removable stent was placed (l" Fig. 4). After 60 days, the stent was re− moved (l" Fig. 5). In one patient the stent gave mild tenesmus, which was alleviat− ed by analgesic drugs. In both patients the neo−anastomosis (l" Fig. 6) was still wide open and func− tioning well after 24 months. Even in such difficult cases, in which the use of surgery seemed inevitable and further− more not free of risks, the cooperation be− tween endoscopist and radiologist made conservative treatment possible. The placement of removable SEMS in order to maintain an adequate lumen and to elim− inate any possible leak was demonstrated to be a safe and efficient technique.