An improvement in the quality of life after performing endoscopic balloon dilation for postoperative anastomotic stricture of the rectum

Abstract

A 55-year-old woman underwent a low anterior resection for rectal cancer 7 years earlier at a different hospital. Thereafter, she often had such symptoms as abdominal pain, frequent bowel movements, and constipation. We considered postoperative bowel adhesion to be the cause of these symptoms, and a laparoscopic adhesiotomy was therefore performed twice. However, the symptoms did not substantially improve thereafter. A colonoscope of conventional diameter could barely pass through the anastomotic site of the operation, but we initially judged the anastomotic stricture to not be severe. However, we finally determined the anastomotic stricture to be the cause of these symptoms: X-ray examinations frequently showed the blockage of feces or the collection of gas images in the colon when the symptoms occurred. We therefore performed endoscopic balloon dilation (EBD) after performing electroincision of the scar tissue of the anastomotic ring. We dilated the area of the lesion to a diameter of 20 mm using the EBD technique, and thereafter the patient finally showed an improvement in quality of life. There have been some reports describing the usefulness of EBD for the treatment of colorectal anastomotic stricture. Past studies have reported the indications of EBD to include stricture, which is defined as a narrowed anastomosis through which a 12-mm-diameter colonoscope cannot be passed. Nevertheless, it seemed that when the clinical manifestations of anastomotic stricture are clear, such as those observed in our case, we should not too strictly adhere to this definition.