Zhang Bao-Zhen, Wang Yi-Dan, Liao Ye, Zhang Jing-Jing, Wu Yu-Fan, Sun Xiao-Lin, Sun Si-Yu, Guo Jin-Tao
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
Department of Endoscopy Center, Liaoyang Liaohua Hospital, Liaoyang 111000, Liaoning Province, China.
World J Clin Cases. 2020 Dec 6;8(23):6086-6094. doi: 10.12998/wjcc.v8.i23.6086.
Abscess formation is one of the complications after radical resection of rectal cancer; cases with delayed postoperative anastomotic abscess are rare. Here, we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery. Ultimately, the patient was diagnosed and treated by endoscopic fenestration. In addition, we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.
A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma. Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria, and a submucosal tumor was suspected. The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography, which revealed no thickening or strengthening of the anastomotic wall. In order to clarify the origin of the lesion and obtain the pathology, endoscopic fenestration was performed. After endoscopic procedure, a definitive diagnosis of delayed anastomotic submucosal abscess was established. The patient achieved good recovery and prognosis after the complete clearance of abscess.
Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.
脓肿形成是直肠癌根治术后的并发症之一；术后吻合口延迟性脓肿病例较为罕见。在此，我们报告一例直肠癌手术后出现吻合口脓肿并伴有黏膜下肿瘤的罕见病例。最终，该患者通过内镜开窗术得以诊断和治疗。此外，我们回顾了关于脓肿作为直肠癌手术后并发症出现的相关文献。
一名有直肠癌切除病史的57岁男性，主诉吻合口造口附近有一光滑隆起。内镜超声检查显示一个起源于固有肌层的低回声结构，怀疑为黏膜下肿瘤。该患者随后被转诊至我院，接受了盆腔增强计算机断层扫描，结果显示吻合壁无增厚或强化。为明确病变起源并获取病理，进行了内镜开窗术。内镜手术后，确诊为延迟性吻合口黏膜下脓肿。脓肿完全清除后，患者恢复良好，预后佳。
内镜开窗术对于诊断/治疗直肠癌术后延迟出现的肠道光滑隆起可能是安全有效的。
