Computed tomography-guided endoscopic recanalization of a completely obstructed rectal anastomosis.

A 44-year-old man presented with complete obstruction of a colorectal anastomosis. He had undergone laparoscopic resection of the sigmoid colon 9 months previously for colonic perforation caused byendoscopic resectionof a Peutz–Jeghers polyp. Surgical resection and reconstruction of the anastomosis, including diverging ileostomy, had been performed 6 months later because of anastomotic stricture and leakage. Closure of the ileostomy had been planned for 3 months later but high-pressure fluoroscopy showed no passage of contrast medium through the anastomosis and endoscopy confirmed complete obstruction with the former lumen being unidentifiable (●" Fig.1). The anastomosis could not be reached endoscopically through the ileostomy because of peritoneal adhesions. A computed tomography (CT) scan was performed and the colon was filled with air through the ileostomy. A gastroscope was advanced through the rectum and placed close to the anastomosis. The CT scan showed a membrane at the tip of the endoscope thatwas completely separating the descending colon and the rectum (●" Fig.2a). An incision of the membrane was performed under CT guidance using a needle-knife (OE11018N3; Endo-Flex, Voerde, Germany), and a guidewire was advanced through the incision. The CT scan confirmed the intracolonic position of thewire (●" Fig.2b) and dilation using a wire-guided balloon (M00558680; Boston Scientific, Natick,Massachusetts, USA)was Fig.2 Computed tomography (CT) scan showing: a the endoscope in the rectum and the air-filled descending colon, which are separated by a membrane; b the correctly positioned guidewire that had been advanced into the decending colon after incision of the membrane.