Endoscopic management of complete colonic obstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Metastatic rectal cancer can necessitate complex surgical interventions, including colostomy and ileostomy.
• Post-operative complications such as large bowel obstruction can occur after colorectal surgery.
• Management of bowel obstruction following ostomy reversal presents a clinical challenge.

Purpose of the Study:

• To describe a novel endoscopic approach for managing a large bowel obstruction after ileostomy closure.
• To evaluate the efficacy of a rendezvous colonoscopy with balloon dilation in relieving distal colonic obstruction.

Main Methods:

• A patient with a large bowel obstruction post-ileostomy closure underwent cecostomy tube placement for decompression.
• A rendezvous colonoscopy was performed, navigating both antegrade through the cecostomy and retrograde through the rectum.
• Endoscopic balloon dilation was utilized to traverse and dilate the obstructing mucosa.

Main Results:

• The rendezvous colonoscopy successfully traversed the obstructed segment.
• Endoscopic balloon dilation relieved the large bowel obstruction.
• The patient's symptoms of nausea, vomiting, and abdominal distention resolved post-procedure.

Conclusions:

• Rendezvous colonoscopy combined with endoscopic balloon dilation is a viable, non-surgical option for managing complex large bowel obstructions.
• This technique offers a minimally invasive alternative to surgical diversion in select patients.
• Cecostomy tube placement facilitates endoscopic access for managing distal colonic pathology.