Magnetic compression anastomosis with atypical anastomosis for anastomotic stenosis of the sigmoid colon: a case report

Abstract

Background: Magnetic compression anastomosis (MCA) is mainly applied in the gastrointestinal and biliary tracts through a nonsurgical procedure that can create an anastomosis similar to that obtained through surgery. Magnets usually adsorb in the end-to-end direction (end-to-end anastomosis), exert a strong magnetic force and create an anastomosis according to the size of the magnets. Regular endoscopic dilation is required to prevent restenosis when the anastomotic size is small. We report a case in which MCA was successfully used to treat anastomotic stenosis of the sigmoid colon; the magnets adsorbed in the side-to-side direction rather than the end-to-end direction and generated a wide anastomosis in a short time that did not require endoscopic dilation. Case presentation: An 81-year-old woman was admitted to our hospital to treat anastomotic stenosis of the sigmoid colon for closure of transverse colostomy. Two years prior, the Hartmann operation and drainage were performed at other hospitals due to perforated diverticulitis of the sigmoid colon. Obstruction of the sigmoid colostomy occurred, and a transverse colostomy was performed. One year after the first surgery, high anterior resection was performed, but anastomotic stenosis occurred, causing obstruction. MCA was planned because the patient had a history of multiple operations and was expected to have strong adhesions postoperatively. MCA was safely performed, but two magnets were accidently adsorbed in the side-to-side direction. The magnet position could not be changed. The two magnets were expected to move and adsorb in an end-to-end direction naturally due to bowel movements. The magnets that adsorbed in the side-to-side direction dropped from the anus 5 days after treatment, and the anastomosis was observed by colonoscopy. Three ileus tubes were placed from the transverse colostomy beyond the anastomosis to prevent restenosis. Colonoscopy showed that the anastomosis diameter was wider than expected at 14 days after treatment, and endoscopic dilation was not necessary. No complications were observed in this patient's postoperative course. Finally, closure of the patient's colostomy was successfully performed. Conclusions: MCA with side-to-side anastomosis generated a wide anastomosis in a short time.

Novel deformable self-assembled magnetic anastomosis ring for endoscopic treatment of colonic stenosis via natural orifice

“…Magnetic compression anastomosis or magnamosis, a novel technique, can be used for managing digestive tract anastomosis[ 7 - 9 ], vascular anastomosis[ 10 , 11 ], pathologic fistula[ 12 ], and therapeutic fistula[ 13 ]. The use of magnamosis along with endoscopy for treating gastrointestinal stenosis has been reported[ 14 ]. The cylinder or circle is the most commonly used shape of the magnet in such cases.…”

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation

“…Magnetic compression anastomosis (MCA) is a recanalization method utilizing the attraction between anastomotic devices made of magnetic materials to compress the parietal layer or tissue of the viscera, thus causing local ischemia or necrosis. [ 3 ] MCA has been applied in the biliary tract, gastrointestinal tract, and vascular anastomosis preliminarily, with remarkable efficacy. [ 3 , 4 ] MCA was performed in the treatment of ureterostenosis after kidney transplantation based on these advantages that were reported previously.…”

“…[ 3 ] MCA has been applied in the biliary tract, gastrointestinal tract, and vascular anastomosis preliminarily, with remarkable efficacy. [ 3 , 4 ] MCA was performed in the treatment of ureterostenosis after kidney transplantation based on these advantages that were reported previously.…”

磁石の誤飲による消化管穿孔を生じた症例報告へのコメント(Comments on the case report of accidental ingestion of rare–earth multiple magnets)

“…考察に述べられています 1)が，これまでの知見に乏しく，誤飲の内容が判明しても，緊急手術の施行時期に関しては，十分なコンセンサスが得られていないと考えられます 3)。また，誤飲した数が正確にわかれば，対応が異なります 4)。また，腹膜刺激症状などの所見がなく，全身状態が安定していれば，準緊急的な待機手術でも対応できる可能性があります 4)。近年，Kamadaら 5)は，磁石を用いて非侵襲的に消化管吻合を行う治療を報告しており，「適切」に消化管内に磁石を配置できれば，開腹せずに腹腔内の治療が行える可能性を示しました。接着した磁石自体は，消化管内に脱落して，排泄されます。…”