EUS-guided management of anastomotic stricture: A case report.

INTRODUCTION AND IMPORTANCE: Anastomotic stenosis after low anterior resection is a serious complication and at times even requires surgical revision of the anastomosis. CASE PRESENTATION AND CLINICAL DISCUSSION: The patient presented with a 4.0 cm tubulovillous adenoma of the proximal rectum and underwent low anterior resection with loop ileostomy and subsequent reversal. The case was complicated by complete anastomotic stenosis. A novel technique was utilized to create an Endoscopic Ultrasound (EUS)-guided neo-anastomosis endoscopically. CONCLUSION: EUS-guided creation of a neo-colorectal anastomosis is a safe and effective alternative to surgical anastomosis revision of a completely stenosed anastomosis.

Rectal advancement flap repair of rectourethral fistula: a 20-year experience.

PURPOSE: Several procedures have been described for the management of rectourethral fistula. There has been no consensus on the best method of repair. The aim of this study was to review our experience with treatment of rectourethral fistula, focusing on the outcomes of rectal advancement flap repair. METHODS: Data collected included demographics, cause, procedure type, presentation, operative details, and morbidity. Telephone follow-up was conducted to evaluate functional outcome and quality of life. RESULTS: From 1981 to 2001, 23 male patients (age, 54 +/- 15 years) were treated for rectourethral fistula. Fecal diversion alone was performed in seven patients (30 percent), and urinary diversion alone was performed in one patient (4 percent). Both fecal and urinary diversion were performed in 12 patients (52 percent), and no diversion was performed in 3 (13 percent). Four patients were managed conservatively with diversion only. Nineteen patients underwent definitive repair. Rectal advancement flap repair was used in 12 (52 percent) of the cases. Postoperative length of stay was 4.5 +/- 4 days. Patients were followed up for an average of 31 +/- 33.4 months. Rectal advancement flap achieved primary closure in 8 (67 percent) of 12 patients. There were four recurrences. Two patients underwent successful repeat repair, for a final success rate of 83 percent. Morbidity associated with rectal advancement flap was 8 percent (1/12 patients). Cleveland Global Quality of Life score averaged 0.82 +/- 0.13. CONCLUSION: The rectal advancement flap provides an effective repair for rectourethral fistula. Successful repair can be achieved in a majority of patients with minimal morbidity, short length of stay, and a good postoperative quality of life.