Hydrostatic balloon dilatation of benign colonic anastomotic strictures

From 1985 to 1990, 25 patients with benign colorectal anastomotic strictures were treated. The majority of the patients presented with decreasing stool caliber and abdominal cramps. Most of the strictures were secondary to anastomosis utilizing the EEA^® stapling device (United States Surgical Corp., Norwalk, CT) for malignant neoplasm. Under IV sedation, strictures were dilated endoscopically with the TTS^® balloon (Microvasive). No complications were encountered in this series. Hydrostatic balloon dilatation is a safe and effective modality for treatment of anastomotic strictures.     

Colonoscopy in the differential diagnosis of colonic strictures

Colonoscopy was performed on ten patients who had colonic strictures demonstrated by barium-enema examination. In all cases the diagnosis of carcinoma had been considered, but it was confirmed by colonoscopic examination, cytology, and biopsies in only two patients. Five patients were shown to have benign inflammatory strictures due to ischemic colitis, ulcerative colitis, Crohn's disease, irradiation colitis, or postoperative strictures. The remaining three patients were shown to have no intrinsic lesion. These eight patients were thereby spared further diagnostic procedures, and even unnecessary laparotomy.     

Nonsteroidal antiinflammatory drug-induced colonic strictures: a case report

Adverse effects of nonsteroidal antiinflammatory drugs can occur throughout the whole gastrointestinal tract. Recently, several cases of "diaphragmlike" thin ileal strictures have been reported. These strictures seem to result from nonsteroidal antiinflammatory drug-induced inflammatory changes and apparently represent a newly recognized nosological entity. The case of a 61-year-old man who gradually developed similar inflammatory changes in the ascending colon during prolonged intake of a slow-release form of diclofenac is presented, and the literature on nonsteroidal antiinflammatory drug-induced intestinal strictures is briefly reviewed.     

Posttraumatic ischemic colonic strictures: Report of a case

Summary An unusual case of a 25-year-old woman with a constipating ischemic stricture of the sigmoid colon diagnosed one and a half years after trauma is presented. The clinicial history of great importance in the differential diagnosis, since the radiographic features are frequently not diagnostic. The Commanding Officer of the U.S. Patterson Army Hospital has reviewed this material, and there is no objection to its presentation and/or publication. The views expressed are solely those of the author.     

Stents for colonic strictures: Materials,designs, and more

Colonic obstruction is one of the common manifestations of colon cancer. Historically, the treatment of malignant colonic obstruction consisted of surgical removal of the obstructing tumor, if possible, and decompression of the bowel with an ostomy. Self-expandable metal stents (SEMS) have now been used effectively for nonsurgical relief of malignant colonic obstruction, either for palliative care or as a bridge to elective surgery. Since the introduction of SEMS insertion technique in the early 1990s, multiple studies and reports have been published on the outcomes of SEMS in treating large bowel obstruction. SEMS are now recommended as an initial treatment of choice for acute left-sided colonic obstruction by surgical groups. SEMS insertion may be helpful to complete colonoscopy screening before surgery to detect any synchronous neoplasm proximal to a malignant colonic obstruction. SEMS insertion would also buy more time for a selected group of patients who may benefit from chemoradiation before surgery. This article reviews the development of colorectal stents, designs, materials, various types of colonic stents used in the treatment of colonic strictures, indications for their insertion, outcomes, limitations, complications, and future directions of the colonic stents.     

Etiology of colonic strictures in South African black and Indian patients

The etiology of colonic strictures in 263 South African black and Indian patients is presented. Nonmalignant lesions accounted for strictures in two-thirds of the patients and included amebiasis (27), tuberculosis (24), nonspecific colitis (30), ulcerative colitis/Crohn's colitis (11) and other lesions (36). Malignant lesions caused strictures in approximately a third of the black and Indian patients, which is higher than in other reported series in blacks. Accurate clinical diagnosis is difficult and early histologic confirmation is mandatory in order to institute rational management. Strictures of the right colon in the black population are more likely to be benign, except in younger patients. Leftsided colonic strictures have an equal chance of being benign or malignant, and early histologic confirmation is essential. The coexistence of an underlying malignant lesion in association with an inflammatory lesion in an endemic area should always be considered, particularly if it fails to respond to empirical therapy within a short period of time.     

Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases

Benign postoperative anastomotic strictures are frequent. OBJECTIVES: To evaluate the results of endoscopic dilatations and to propose an alternative treatment to surgery. METHODS: Between 1994 and 2001, 27 patients (16 female, 11 male, median 70 years old) with colonic anastomotic strictures were treated with pneumatic or mechanical dilatation. Eleven patients (40.7%) had been operated on for colon carcinoma, 2 for colorectal adenoma and 14 (51.8%) for complicated diverticular disease. A left colectomy was performed in 12 patients and a sigmoid colectomy in 15. Anastomoses were stapled in 25 cases. RESULTS: Twenty one patients were symptomatic (78%). The median time to diagnosis after surgery was 3 months (range: 21 days-4 years). Dilatation was possible in 26 cases (96.3%). The total number of dilatation sessions was 51 and the median number of sessions by patient was 2 (range: 1-4). Only one session was done in 11 patients (40.7%). There was one case of bowel perforation (1.9%) with the guide wire. In 21 cases (77.7%), the patients were no longer symptomatic and failure was observed in 5 cases. Surgery was necessary for 3 patients, with stenosis recurrence in 1. Three patients were treated with a self expanding metal stent. CONCLUSION: Endoscopic dilatation is a simple and efficient method. Therefore, it might be considered as the first line approach for benign anastomotic strictures. Self expanding metal stent could be an alternative to surgery, in case of failure.     

Ileal and right colonic strictures due to prolonged non steroidal anti-inflammatory drug intake

Ileal and right colonic strictures due to long term NSAID intake are well known but rare. We report the case of a patient with rheumatoid arthritis presenting with one ileal, as well as a right and transverse colonic stricture. The latter two were treated by dilatation under colonoscopy, but due to an associated recurrence, and the necessity of treating the ileal stricture which was inaccessible, a transverse ileocolonic shunt was proposed under local anesthesia. Ileal and colonic strictures due to long term NSAID intake should first be treated, if possible, by discontinuing the drug, then by pneumatic dilatations and finally, if necessary, by surgery usually resection. The advantage of a gastrointestinal shunt is that it can be performed under local anesthesia in patients who are often in poor condition.     

Endoscopic balloon dilation of colonic and ileo-colonic Crohn's strictures: long-term results.

The long-term effects of endoscopic dilation of colonic or ileo-colonic Crohn's disease strictures were analyzed. In 18 patients with a Crohn's disease-related low gastrointestinal stricture, the stenosis was dilated using through-the-scope (TTS) balloon catheters. A dilation to a diameter of 18 mm was always attempted. Treatment was successfully carried out in 16 patients, and was followed by immediate symptomatic relief in 14 patients. Long-term success was observed in nine patients. There were no complications. Balloon catheter dilation of a colonic stricture or stricture of an ileo-colonic anastomosis was found to be safe and effective. This treatment modality can be an alternative to surgery in a selected group of patients.     

Dilation of colonic strictures by intralesional injection of infliximab in patients with Crohn's colitis

BACKGROUND: Intestinal stenosis is a frequent complication of Crohn's disease, often leading to repeated bowel obstruction and surgery. The prevalence of small bowel stenosis has ranged from 20% to 40% and from 7% to 15% in patients with colonic disease. Although balloon dilation is the initial preferred approach, many patients eventually restenose and require surgical resection or stricturoplasty. Infliximab, a chimeric IgG1 kappa monoclonal antibody against TNF-alpha, has been effective in the treatment of enteric as well as fistulous complications of Crohn's disease. Repeated systemic administration has been successful for active inflammatory disease yet has been reported to be ineffective in the treatment of strictures. Although the TREAT registry has shown systemic infliximab to be safe in the long term, there is concern regarding infectious as well as neoplastic complications. METHODS: This report describes 3 patients refractory to all medical therapy including systemic infliximab. RESULTS: In all 3 patients, dilation of a colonic stricture was accomplished by injection of infliximab, via the sclerotherapy technique, into the distal and medial portions of the stricture. CONCLUSIONS: Infliximab was shown to be effective in the treatment of strictures in 3 patients.     

Malakoplakia of the colon and recurrent colonic strictures in a patient with primary hypogammaglobulinemia

A nine-year old boy with primary hypogammaglobulinemia and recurrent colonic strictures who developed malakoplakia of the colon is reported on. Such an association has not been reported previously. The development of colonic strictures is not considered a gastrointestinal manifestation of hypogammaglobulinemia. Malakoplakia of the colon is a rare disease, with 26 cases being reported to date. Only five children under age 13 have been reported with colonic malakoplakia and none with hypogammaglobulinemia. Hypogammaglobulinemia should be added to the growing list of conditions predisposing to the development of malakoplakia.     

Non-steroidal anti-inflammatory drug (NSAID)-induced colonic strictures and perforation: A case report

Although non-steroidal anti-inflammatory drug-induced colopathy is well described, colonic perforations complicating non-steroidal anti-inflammatory drug intake are rare. We report a patient with rheumatoid arthritis who was on long-term diclofenac and presented with early colonic stricture formation and a caecal perforation, which to the best of our knowledge, has only been reported once before. It is important to suspect this diagnosis in patients on non-steroidal anti-inflammatory drug therapy who present with an acute abdomen.     

Post-operative biliary strictures

Post-operative biliary stricture is a cumbersome condition, secondary to biliary or vascular damage. Its risk factors include biliary or vascular anatomical variants, local inflammation, and poor surgical expertise. Intra-operative diagnosis is difficult, and in most cases, patients present with obstructive symptoms within a few weeks. Magnetic resonance cholangiography is a pivotal test to confirm the clinical picture, to study the level of the damage, and to guide treatment. Nowadays, endoscopic stenting is the first-line treatment in most centers. Multi-stenting treatment achieves long-term clinical success for more than 90% of patients, however multiple procedures are needed. In order to optimize healthcare provider costs, shorter duration endotherapies with covered metal stents are under evaluation. Radiological and surgical approaches are considered in the event of endoscopy failure.     

Pancreatic duct strictures

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