Kolonun benign anastomoz darlığında rektal mesalazin tedavisi sonrası endoskopik balon dilatasyonu

Yıl 2018, Cilt: 26 Sayı: 1, 34 - 36, 26.04.2018

Enver Akbaş Serkan Öcal , Abdullah Emre Yıldırım , Reskan Altun Murat Korkmaz , Haldun Selçuk

https://doi.org/10.17940/endoskopi.434939

Öz

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olmasına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anastomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlıklarının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospektif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endoskopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez.

Anahtar Kelimeler

Kolon anastomoz darlığı, mesalazin, kolon balon dilatasyonu

Endoscopic balloon dilatation after rectal mesalazine treatment within an uncertainty of colonic anastomosis

Öz

Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anastomosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient underwent balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not require hospitalization.

Anahtar Kelimeler

Kolon anastomoz darlığı, mesalazin, kolon balon dilatasyonu

Kaynakça

• 1. Geller A, Gal E. Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies. Endoscopic treatment of benign anastomotic colorectal stenosis with electrocautery. Gastrointest Endosc. 2001;54:277–279.
• 2. ASGE Technology Committee Tools for endoscopic stricture dilation. Gastrointest Endosc. 2004;59:753–760.
• 3. Luchtefeld MA, Milsom JW, Senagore A, et al. Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership. Dis Colon Rectum. 1989;32:733–736.
• 4. Chung RS, Hitch DC, Armstrong DN. The role of tissue ischemia in the pathogenesis of anastomotic stricture. Surgery. 1988;104:824–829.
• 5. Polglase AL, Hughes ES, McDermott FT, et al. A comparison of end-toend staple and suture colorectal anastomosis in the dog. Surg Gynecol Obstet. 1981;152:792–796.
• 6. Brower RA, Freeman LD. Balloon catheter dilation of a rectal stricture. Gastrointest Endosc. 1984;30:95–97.
• 7. Virgilio C, Cosentino S, Favara C, et al. Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: shortterm and long-term results. Endoscopy. 1995;27:219–222.
• 8. Kimmey MB, Al-Kawas FH, Gannan RM, Saeed ZA, Carr-Locke DL, Edmundowicz SA, et al. Technology assessment status evaluation: balloon dilation of gastrointestinal tract strictures. Gastrointest Endosc 1995;42:608-11.
• 9. Werre A, Mulder C, Van Heteren C, Bilgen ES. Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies. Endoscopy 2000;32:385-8.
• 10. Pietropaolo V, Masoni L, Ferrara M, Montori A. Endoscopic dilation of colonic postoperative strictures. Surg Endosc 1990;4:26-30.
• 11. Aston NO, Owen WJ, Irving JD. Endoscopic balloon dilatation of colonic anastomotic strictures. Br J Surg 1989;76:780-2.
• 12. Venkatesh KS, Ramanujam PS, McGee S. Hydrostatic balloon dilatation of benign colonic anastomotic strictures. Dis Colon Rectum 1992;35:789-91.
• 13. Dinneen MD, Motson RW. Treatment of colonic anastomotic strictures with ‘‘through the scope’’ balloon dilators. J R Soc Med 1991;84:264-6.
• 14. Fregonese D, Di Falco G, Di Toma F. Balloon dilatation of anastomotic intestinal stenoses: long-term results. Endoscopy 1990;22:249-53.
• 15. Hagiwara A, Sakakura C, Shirasu M, Torii T, Hirata Y, Yamagishi H. Sigmoidofiberscopic incision plus balloon dilatation for anastomotic cicatricial stricture after anterior resection of the rectum. World J Surg 1999;23:717-20.
• 16. Luck A, Chapuis P, Sinclair G, Hood J. Endoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures. ANZ J Surg 2001;71:594-7.
• 17. Brandimarte G, Tursi A, Gasbarrini G. Endoscopic treatment of benign anastomotic colorectal stenosis with electrocautery.Endoscopy 2000;32:461-3.
• 18. M. Albertsmeier et al.Treatment of a completely obstructed colonic anastomotic stricture using a CT-guided endoscopic rendezvous technique. Endoscopy. 2011;43 Suppl 2:E5-6. Epub 2011 Jan 26
• 19. Curcio G et al. Completely obstructed colorectal anastomosis: a new non-electrosurgicaloscopic approach before balloon dilatation. World J Gastroenterol. 2010 Oct 7;16(37):4751-4.
• 20. Di Giorgio P, De Luca L, Rivellini G et al. Endoscopic dilation of benign colorectal anastomotic stricture after low anterior resection: A prospective comparison study of two balloon types. Gastrointest Endosc. 2004 Sep;60(3):347-50.
• 21. Delaunay-Tardy K, Barthélémy C, Dumas O, Balique JG, Audigier JC. Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases. Gastroenterol Clin Biol. 2003 Jun;27(6-7):610-3.