Computed tomography-guided endoscopic needle knife therapy for ileal pouch sinus

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• Ileal pouch-anal anastomosis (IPAA) surgery can lead to complications like anastomotic leaks, abscesses, and chronic sinuses.
• Traditional management of these complications involves surgical intervention.
• Endoscopic needle knife sinusotomy (NKSi) has emerged as a less invasive alternative.

Observation:

• The success of NKSi relies on accessing the sinus via its orifice from the pouch lumen.
• A closed sinus orifice presents a significant challenge, creating an isolated abscess cavity.
• This case involved a complicated presacral sinus with a closed orifice, initially not amenable to standard NKSi.

Findings:

• A modified approach was required for the challenging case.
• Computed tomography (CT)-guided placement of a guide wire facilitated access to the isolated sinus.
• Subsequent endoscopic needle knife sinusotomy (NKSi) was successfully performed after guide wire placement.

Implications:

• This case demonstrates a viable strategy for managing complex presacral sinuses with closed orifices after IPAA.
• CT-guided intervention can enable endoscopic treatment in previously inaccessible cases.
• Expanding the utility of NKSi for challenging sinus anatomies may improve patient outcomes and reduce the need for open surgery.