Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China.
Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China.
World J Surg Oncol. 2022 May 6;20(1):145. doi: 10.1186/s12957-022-02610-5.
With the development of laparoscopic techniques and the broad clinical application of various anastomotic types, anal-preserving low anterior rectal resection and ultra-low anterior rectal resection have been popularized. Some patients with rectal cancer have retained their anus and improved their quality of life. Nevertheless, the incidence of postoperative anastomotic stenosis remains high, and anastomotic occlusion is even rarer.
We report a case of anastomotic occlusion in a patient with rectal cancer, which occurred after undergoing laparoscopic low anterior rectal resection + prophylactic terminal ileal fistulation at our department. Under endoscopy, we used a small guidewire to break through the occluded anastomosis, thereby finding the lacuna. After endoscopic balloon dilation, digital anal dilatation, and continuous dilator-assisted dilation, the desired efficacy was achieved, ultimately recovering ileal stoma. Postoperative follow-up condition was generally acceptable, without symptoms like abdominal pain, bloating, or difficulty in defecation.
Numerous factors cause postoperative anastomotic stenosis in patients with rectal cancer. Complete occlusion of anastomosis occurs relatively rare in clinical practice, and is challenging to treat. This case was our first attempt to remove the anastomotic occlusion successfully, which avoided re-operation or pain from the permanent fistula.
随着腹腔镜技术的发展和各种吻合类型的广泛临床应用，保肛低位前切除术和超低位前切除术得到了普及。一些直肠癌患者保留了肛门，提高了生活质量。然而，术后吻合口狭窄的发生率仍然很高，吻合口闭塞更为罕见。
我们报告了一例直肠癌患者在我科行腹腔镜低位前直肠切除+预防性末端回肠造口术后发生吻合口闭塞的病例。在内镜下，我们使用小导丝突破闭塞吻合口，从而找到了腔隙。经过内镜球囊扩张、数字肛门扩张和连续扩张器辅助扩张，达到了预期的效果，最终恢复了回肠造口。术后随访情况一般可接受，无腹痛、腹胀或排便困难等症状。
多种因素导致直肠癌患者术后吻合口狭窄。吻合口完全闭塞在临床上较为少见，治疗较为困难。本例是我们首次成功尝试取出吻合口闭塞，避免了再次手术或永久性造口带来的痛苦。
