A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively.Nine months later,colonosco...A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively.Nine months later,colonoscopy performed through the stoma showed complete anastomotic obstruction.The mucosa of the proximal sigmoid colon was atrophic and whitish.Ten days after the colonoscopy,the patient presented in shock with abdominal pain.Abdominal computed tomography scan showed hepatic portal venous gas(HPVG) and a dilated left colon.HPVG induced by obstructive colitis was diagnosed and a transverse colostomy performed emergently.His subsequent hospital course was unremarkable.Rectal anastomosis with diverting ileostomy is often performed in patients with low rectal cancers.In patients with anastomotic obstruction or severe stenosis,colonoscopy through diverting stoma should be avoided.Emergent operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.展开更多
A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomoti...A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.展开更多
文摘A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days postoperatively.Nine months later,colonoscopy performed through the stoma showed complete anastomotic obstruction.The mucosa of the proximal sigmoid colon was atrophic and whitish.Ten days after the colonoscopy,the patient presented in shock with abdominal pain.Abdominal computed tomography scan showed hepatic portal venous gas(HPVG) and a dilated left colon.HPVG induced by obstructive colitis was diagnosed and a transverse colostomy performed emergently.His subsequent hospital course was unremarkable.Rectal anastomosis with diverting ileostomy is often performed in patients with low rectal cancers.In patients with anastomotic obstruction or severe stenosis,colonoscopy through diverting stoma should be avoided.Emergent operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.
文摘A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.
