A Case of Fecal Ileus Caused by Fecal Impaction in the Intestine at the Anal Side of a Functional End-to-End Anastomotic Site

Negami, Naoki; Satou, Masahiko; Watabe, Suguru; Saitou, Tetsuya; Ishido, Yasunori; Yamada, Masaki

doi:10.3919/jjsa.71.1216

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…Of 3 patients treated nonoperatively, Naegami et al [ 4 ] removed an impacted fecal mass at the anastomotic site with a Gastrografin enema, followed by only 1 session of colonoscopic fragmentation. Kubo et al [ 8 ] performed colonoscopic fragmentation 4 times using snares and alligator forceps over 4 consecutive days.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Homma¹,

Mimura²,

Sadatomo³

et al. 2021

Case Rep Gastroenterol

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Fecalomas most commonly occur in constipated patients and are rarely reported after colectomy. A 55-year-old Japanese female presented with a fecaloma after colectomy, which was impacted at a functional end-to-end anastomosis (FEEA) site. Four and a half years ago, she underwent sigmoidectomy for colon cancer. A follow-up computed tomography (CT) scan revealed an 11 cm incidental fecaloma. The patient was advised to undergo surgery, but she desired nonoperative management because of minimal symptoms, and was referred to our institution. On the day of admission (day 1), mechanical fragmentation of the fecaloma was attempted during the first colonoscopy. Although a large block of stool was evacuated after a second colonoscopic fragmentation on day 8, the third colonoscopy on day 21 and CT scan on day 22 showed no significant change in the fecaloma. Frequent colonoscopic fragmentation was performed, with a fourth, fifth, and sixth colonoscopy on days 24, 29, and 31, respectively. After the size reduction was confirmed at the sixth colonoscopy, the patient was discharged home on day 34. The fecaloma completely resolved after the seventh colonoscopic fragmentation on day 44. Sixteen months after treatment, there is no evidence of recurrent fecaloma. According to the literature, risk factors for fecaloma after colectomy include female gender, left-side colonic anastomosis, and FEEA. FEEA might not be recommended for anastomoses in the left colon, particularly in female patients, to avoid this complication. Colonoscopic fragmentation is recommended for fecalomas at an anastomotic site after colectomy in patients without an absolute indication for surgery.

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Section: Discussion/conclusionmentioning

confidence: 99%

Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Homma¹,

Mimura²,

Sadatomo³

et al. 2021

Case Rep Gastroenterol

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“…Functional end-to-end anastomosis using an autosuture device as reported by Steichen [8] is currently the most widely used of all anastomoses, where, compared with hand-sewn anastomosis, the anastomosis of the intestinal tract with a different diameter is easier, the time required for the anastomosis is shorter, and the complications at the anastomosis site are less likely [9]. To date, 5 cases of blind pouch syndrome have been reported to occur at the functional end-to-end anastomosis site after colectomy (Table 1) [2-6]. The time from surgery to the onset of symptoms is reported to vary between 15 and 52 months among these reports; of these, 4 cases were associated with enterolithiasis, with 2 and 1 of these also associated with ileus and perforation peritonitis, respectively, and 1 case without enterolithiasis also associated with sigmoid colon volvulus.…”

Section: Discussionmentioning

confidence: 99%

“…To date, gastrointestinal series and CT [2, 3] have been reported as useful modalities for the diagnosis of blind pouch syndrome at functional end-to-end anastomosis sites. Recently, coronal reformatted multidetector CT has been shown to aid in detecting a blind pouch by revealing a dilated tract or surgical suture [6, 7, 10].…”

Section: Discussionmentioning

confidence: 99%

“…Blind pouch syndrome is defined as a series of symptoms such as anemia, intermittent abdominal pain, diarrhea, and weight loss, all of which are associated with the formation of a blind pouch secondary to an intestinal anastomosis [1]. Most cases of blind pouch syndrome were shown to be secondary to side-to-side or side-to-end anastomosis, but recently cases of blind pouch have been reported as occurring secondary to functional end-to-end anastomosis [2-7]. Enterolithiasis associated with blind pouch syndrome secondary to functional end-to-end anastomosis is rare and its endoscopic and radiological features remain poorly described.…”

Section: Introductionmentioning

confidence: 99%

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Blind Pouch Syndrome-Associated Enterolithiasis Successfully Treated with Colonoscopy

Kubo

Suzuoki

Kimura

et al. 2020

Case Rep Gastroenterol

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Enterolithiasis associated with blind pouch syndrome secondary to functional end-to-end anastomosis is rare, and its endoscopic and radiological features remain poorly described. A 72-year-old woman was admitted to our hospital for abdominal pain and difficulty defecating. Colonoscopy (CS) with Gastrografin revealed a 10 × 8 cm calculus, an anastomotic ulcer, a blind pouch, and an end-to-end anastomosis in the transverse colon. The calculus was successfully crushed and removed with snares and alligator forceps through CS during the ensuing 4-day period. To our knowledge, this is the first report describing the endoscopic and radiological features of blind pouch syndrome-associated enterolithiasis successfully treated with CS.

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“…Factors that have helped FEEA to become more widespread include its convenience and association with few complications. In Japan, however, a few reports of intestinal obstruction due to saccular extension of the anastomotic site of FEEA with blockage by intestinal contents have been published in recent years [2] [3] [4]. Because only a few reports are available, an official term for this condition has not been established.…”

Section: Discussionmentioning

confidence: 99%

Techniques for Avoiding Saccular Extended Obstruction at the Anastomotic Site of Functional End-to-End Anastomosis

Yoshida¹,

Ietsugu²,

Okamoto³

et al. 2017

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Saccular extended obstruction is generated when the anastomotic site of functional end-to-end anastomosis is extended saccularly and blocked by intestinal contents. This is a specific complication of functional end-to-end anastomosis. Saccular extended obstruction of the anastomotic site of functional end-to-end anastomosis causes postoperative intestinal obstruction. Saccular extended obstruction places a heavy burden on patients because surgery is necessary for treatment of intestinal obstruction due to saccular extended obstruction. However, saccular extended obstruction is not a commonly recognized complication. The greatest factor contributing to the development of saccular extended obstruction is an acute angle between the portions of the intestinal tract oral and aboral to the anastomotic site. When this angle approaches obtuse angle, preferably close to a straight line, stagnation of the intestinal contents does not occur at the anastomotic site of functional end-to-end anastomosis and saccular extended obstruction is avoided. For making the angle of anastomotic intestinal tracts obtuse or straight, it may be effective that the entry hole of stapling suture instrument creating the anastomotic stoma is closed perpendicular to the intestinal axis.

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A Case of Fecal Ileus Caused by Fecal Impaction in the Intestine at the Anal Side of a Functional End-to-End Anastomotic Site

Cited by 8 publications

References 6 publications

Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Blind Pouch Syndrome-Associated Enterolithiasis Successfully Treated with Colonoscopy

Techniques for Avoiding Saccular Extended Obstruction at the Anastomotic Site of Functional End-to-End Anastomosis

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