Endoscopic and imaging appearance after injection of an ano-rectal bulking agent

Papafragkakis, Haris

doi:10.4253/wjge.v6.i7.324

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Similar to the histopathology of DxHA, endoscopic and imaging descriptions are limited in the anorectal region. One case concerning the endoscopic and computed tomography (CT) appearance of DxHA (Solesta) injections was found in the literature [ 19 ]. An elderly woman who had undergone endoscopic DxHA injections for FI subsequently had an abdominopelvic CT scan two days later.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic, Ultrasonographic, and Histologic Descriptions of Dextranomer/Hyaluronic Acid in a Case of Fecal Incontinence

Irwin

Snow

Orton

et al. 2018

Case Reports in Pathology

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Objective To present a case of fecal incontinence treated with dextranomer/hyaluronic acid (Solesta®) injections, which later caused clinical confusion and avoidable interventions. The endoscopic, ultrasonographic, and histologic appearances of dextranomer/hyaluronic acid will also be reported. Case Presentation A middle-aged Hispanic male who failed conservative management of his fecal incontinence was injected with dextranomer/hyaluronic acid in an attempt to alleviate symptoms. An unrelated screening colonoscopy was performed soon after, revealing a submucosal rectal lesion. Flexible sigmoidoscopy and endoscopic rectal ultrasound with FNA were scheduled for patient for further evaluation. An unknown foreign material was noted under microscopy and, upon attaining additional history, the gastroenterologist uncovered the patient's recent injections of dextranomer/hyaluronic acid. Conclusion Dextranomer/hyaluronic acid for the treatment of fecal incontinence has become more common in recent years. Though the imaging and histologic appearance of this gel-like material is seen in other areas of medicine, equivalent descriptions are limited in the anorectal region. To curb misdiagnoses and prevent unnecessary interventions, it is important to expound on the endoscopic, imaging, and histopathologic features of this tissue-bulking agent in the setting of fecal incontinence and to encourage communication, proper documentation, and easy accessibility to patient health information by all medical staff.

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Section: Discussionmentioning

confidence: 99%

Endoscopic, Ultrasonographic, and Histologic Descriptions of Dextranomer/Hyaluronic Acid in a Case of Fecal Incontinence

Irwin

Snow

Orton

et al. 2018

Case Reports in Pathology

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“…However, this argument is countered by the atypical, more proximal, location of these lesions and the risk of malignancy, such as a rectal carcinoid or gastrointestinal stromal tumor, which would undoubtedly lead many practitioners to offer an attempt at obtaining diagnostic tissue. A report by Papafragkakis et al 3 noted that computed tomography findings after Solesta injection may show mural thickening that may mimic an abscess or tumor. It is important for gastroenterologists and surgeons to be cognizant of the possibility for proximal migration and the endoscopic appearances of bulking agents when faced with such lesions.…”

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confidence: 99%

An Unusual Case of Submucosal Rectal Nodules

2018

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Question: A 60-year-old woman with a history of nonalcoholic fatty liver disease presented to the gastroenterology outpatient office with a 1-year history of chronic right lower quadrant abdominal pain and heartburn. She denied any association with oral intake, weight loss, or rectal bleeding. She had a history of type II diabetes, obesity, hemorrhoids, and unspecified treatment for fecal incontinence in the remote past. During screening colonoscopy performed 7 years prior, a diminutive lipomatous colonic polyp was removed. A computed tomography scan of the abdomen and pelvis was obtained and was normal. Colonoscopy was performed for further evaluation and was notable for 3 separate submucosal nodules in the rectum, measuring 8 to 10 mm in size (Figure A), lying approximately 8 cm from the anal verge. On endosonography, the lesions were hypoechoic and seemed to originate from the muscularis propria in the distal rectum (Figure B). The lesions were firm and did not demonstrate the pillow sign. Bite-on-bite and tunneling biopsies were unsuccessful at obtaining any diagnostic tissue from these mobile lesions. She was, therefore, referred to colorectal surgery for transanal excision. The lesions were mobile, submucosal, firm, smooth, and regular. The largest was resected via a transanal submuscular dissection, excision, and primary closure. The tissue was sent for histopathologic analysis (Figure C) and the patient was discharged on the same day. She had an uneventful recovery. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

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Ultrasound‐guided fine‐needle aspiration of a rectal submucosal nodule

Wang

Mani

Lee

et al. 2019

Diagnostic Cytopathology

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Although endoscopic biopsy of a rectal submucosal nodule may be nondiagnostic, endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) can be an important tool to make diagnosis. We report a case of a female patient who had an EUS‐FNA of a submucosal nodule after a nondiagnostic rectal biopsy. The original diagnosis was erroneously rendered as concerning for necrotic neoplasm. The correct diagnosis of Solesta‐induced foreign body reaction was made on reviewing the slides once the history of remote Solesta injection was made available. This case illustrates the pathognomonic features of Solesta‐induced rectal nodule and underscores the importance of detailed history as well as inclusion of iatrogenic diseases in the differential to prevent erroneous diagnosis and management. Potential pitfalls in cytopathological diagnosis are discussed.

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Endoscopic and imaging appearance after injection of an ano-rectal bulking agent

Cited by 4 publications

References 20 publications

Endoscopic, Ultrasonographic, and Histologic Descriptions of Dextranomer/Hyaluronic Acid in a Case of Fecal Incontinence

Endoscopic, Ultrasonographic, and Histologic Descriptions of Dextranomer/Hyaluronic Acid in a Case of Fecal Incontinence

An Unusual Case of Submucosal Rectal Nodules

Ultrasound‐guided fine‐needle aspiration of a rectal submucosal nodule

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