Turkish Journal of Colorectal Disease (Mar 2024)

A Combination of Dilatation and Stenting for Treatment of Anal Stricture: A Case Report

  • Ömer Faruk İnanç,
  • Wafi Attaallah

DOI
https://doi.org/10.4274/tjcd.galenos.2023.2022-9-5
Journal volume & issue
Vol. 34, no. 1
pp. 36 – 38

Abstract

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Intersphincteric resection (ISR) was introduced recently as an alternative procedure for abdominoperineal resection and sparing the anal sphincter. Anastomosis stricture is a common complication after ISR. In this study, we attempted to maintain the dilatation longer using a stent in combination with dilatation during a single session on a patient who was suffering from anal stricture after an ISR procedure. Six weeks following neoadjuvant chemo-radiotherapy, a 52-year-old woman underwent ISR. She presented to the hospital with a rectal adenocarcinoma at a 3 cm distance from the anal verge. A complete diverting tube ileostomy was performed as a protective stoma instead of a conventional loop ileostomy. The patient reported hard defecation at 6 weeks after surgery. A severe anastomosis stricture was detected during the digital rectal exam. Dilatation was performed under general anesthesia. The lumen was dilated up to 1.5 cm with Hegar dilators, and colonic mucosa were confirmed by a rigid rectoscope. A polyvinyl chloride soft tube with a length of 20 cm and a diameter of 17 mm was used as a stent to maintain the dilatation. Instead of dilatation alone, we combined dilatation with a convenient anal stent. The patient was discharged on the postoperative third day. During the 2 weeks of follow up with the tube, the patient did not report any challenges in terms of mobilization and lifestyle. There was no bleeding. However, tenesmus was described during this 2-week period by the patient. After the removal of the tube on the fourteenth day, the stricture was resolved and defecation was within normal. After a follow-up period of 2 months, there were no reported problems regarding defecation. This treatment modality could be recommended as a first-line treatment instead of surgical revision procedures (e.g., flap or stricturoplasty) in the future because it is a minimally invasive procedure.

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