Kanika A Bowen, MD MMS, Stephen W Abernathy, MD, Richard C Frazee, MD. Texas A&M University – Scott & White Hospital
INTRODUCTION – The endoscopic use of stents in the gastrointestinal tract has been instrumental in the treatment of unresectable esophageal cancer, esophageal leak, and the temporary relief of colonic obstruction. The current use of colorectal stenting has mainly been targeted to the temporary relief of obstruction. Our group will describe the success and novel application for colorectal stenting after anastamotic leak.
METHODS AND PROCEDURES – Two patients at our institution were treated with a covered esophageal stent after anastamotic leak. Both patients agreed to the off-label use of the stents after an informed, detailed discussion. One patient had a delayed presentation with a pelvic abscess two weeks after his elective colostomy takedown with primary anastamosis. At abdominal exploration the area of leak was drained externally. Colonoscopy revealed disruption of one-third of the anastamotic circumference. A 23mm x 18cm covered stent was placed endoscopicly using fluoroscopic guidance. Another patient developed an anastamotic bleed and subsequent anastamotic leak after elective sigmoidectomy in the early postoperative period. In this case, re-exploration revealed minimal intra-abdominal contamination and a 23mm x 18cm covered stent was placed across the anastamosis.
RESULTS – In both patients a covered removable stent was placed to protect the anastamosis and allow for adequate healing time. Both patients passed the colonic stents at home without any squealae and on routine follow-up have had return of normal bowel function with no further anastamotic complications to date. The patient that presented with a delayed anastamotic leak underwent colonoscopy one month after stent placement. This patient had complete, intact mucosal integrity and no evidence of stricture.
CONCLUSION – Anastamotic leak is one of the dreaded complications of colorectal anastamoses and treatment strategies have mainly been directed at drainage and diversion. We report the use of covered stents in the successful management of anastamotic leaks in two patients. We feel the use of covered stents in carefully selected patients allows for anastamotic healing without proximal diversion.
Session Number: Poster – Poster Presentations
Program Number: P538