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DOI: 10.1055/a-2325-2464
Endoscopic recanalization of a completely obstructed colorectal anastomosis using magnets
A male patient who had undergone emergency loop colostomy because of intestinal obstruction secondary to a sigmoid colon tumor subsequently underwent elective rectosigmoidectomy. Endoscopy prior to bowel reconstruction revealed complete stenosis of the colorectal anastomosis ([Fig. 1]). A previous attempt at recanalization using a needle-knife was aborted due to perforation. Following a multidisciplinary discussion, the decision was made to perform magnetic compression anastomosis.
Two 10 × 5-mm neodymium magnets were inserted endoscopically through the efferent loop and rectum and positioned on the oral and rectal sides of the completely obstructed anastomosis. After 4 days, a follow-up colonoscopy revealed recanalization of the stenosis ([Fig. 2], [Video 1]). Additionally, balloon dilation using a 15-mm-diameter hydrostatic balloon was performed to achieve an optimal caliber. The patient underwent bowel transit reconstruction after 6 months and remained asymptomatic at the 1-year follow up.
Quality:
Magnetic compression anastomosis is widely performed in the biliary tract and esophagus but is still in the developmental stage for the gastrointestinal segment. A previous case series indicated its safety and effectiveness [1]. Case reports have described colorectal anastomosis recanalization through techniques such as stricturotomy [2] or in combination with endoscopic ultrasound [3]. Nevertheless, when access to both sides of the obstructed anastomosis is possible, the use of magnets emerges as a technically easier alternative.
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Publication History
Article published online:
05 June 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Kamada T, Ohdaira H, Takeuchi H. et al. New technique for magnetic compression anastomosis without incision for gastrointestinal obstruction. J Am Coll Surg 2021; 232: 170-177.e2
- 2 Lin D, Liu W, Chen Z. et al. Endoscopic stricturotomy for patients with postoperative benign anastomotic stricture for colorectal cancer. Dis Colon Rectum 2022; 65: 590-598
- 3 Ni J, Zhang L, Mao Y. et al. Endoscopic recanalization of complete fibrotic colorectal anastomosis using an endoscopic ultrasound-guided hybrid approach. Endoscopy 2024; 56: E43-E44 DOI: 10.1055/a-2216-1042. (PMID: 38232768)