Fig 3 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
Histopathologic examination. A biopsy specimen from the anastomotic ulcer showed chronic inflammatory cell infiltration (×100).
Source publication
Enterolithiasis associated with blind pouch syndrome secondary to functional end-to-end anastomosis is rare, and its endoscopic and radiological features remain poorly described. A 72-year-old woman was admitted to our hospital for abdominal pain and difficulty defecating. Colonoscopy (CS) with Gastrografin revealed a 10 × 8 cm calculus, an anastom...
Context in source publication
Context 1
... colon. Despite the absence of hallmark symptoms of blind pouch syndrome, i.e., anemia, diarrhea, and weight loss, she was diagnosed with blind pouch syndrome-associated enterolithiasis and underwent colonoscopic treatment. Histopathological examination of a biopsy specimen from the anastomotic ulcer showed chronic inflammatory cell infiltration (Fig. ...
Citations
... To the best of our knowledge, 6 patients with fecaloma have been reported, which developed at the anastomotic site after colorectal surgery [4][5][6][7][8][9] ( Table 2). The English language literature was searched with the key words ("fecaloma" or "fecalith" or "fecal impaction" or "blind loop syndrome" or "blind pouch syndrome" or "stercoral") and ("surgery" or "anastomosis" or "colonic surgery" or "functional end to end" or "side-to-side" or "side-toend" or "hand sewn" or "double stapling" or "DST") on PubMed for papers between January 2001 and February 2021. ...
... The English language literature was searched with the key words ("fecaloma" or "fecalith" or "fecal impaction" or "blind loop syndrome" or "blind pouch syndrome" or "stercoral") and ("surgery" or "anastomosis" or "colonic surgery" or "functional end to end" or "side-to-side" or "side-toend" or "hand sewn" or "double stapling" or "DST") on PubMed for papers between January 2001 and February 2021. Of 657 studies found, only 1 case was identified as a fecaloma, which developed at an anastomotic site after colorectal surgery [8]. The Japanese language literature was also searched with the same key words on Japan Medical Abstracts Society during the same period. ...
... Surgery with colonic resection was performed in 4 patients [5][6][7]9], while nonoperative therapy with colonoscopic fragmentation was carried out in 3 [4,8] (Table 2). Among the 4 patients who underwent surgery, Kawaguchi et al. [5] and Toyosaki et al. [7] performed a colonic resection without any preceding treatment. ...
Fecalomas most commonly occur in constipated patients and are rarely reported after colectomy. A 55-year-old Japanese female presented with a fecaloma after colectomy, which was impacted at a functional end-to-end anastomosis (FEEA) site. Four and a half years ago, she underwent sigmoidectomy for colon cancer. A follow-up computed tomography (CT) scan revealed an 11 cm incidental fecaloma. The patient was advised to undergo surgery, but she desired nonoperative management because of minimal symptoms, and was referred to our institution. On the day of admission (day 1), mechanical fragmentation of the fecaloma was attempted during the first colonoscopy. Although a large block of stool was evacuated after a second colonoscopic fragmentation on day 8, the third colonoscopy on day 21 and CT scan on day 22 showed no significant change in the fecaloma. Frequent colonoscopic fragmentation was performed, with a fourth, fifth, and sixth colonoscopy on days 24, 29, and 31, respectively. After the size reduction was confirmed at the sixth colonoscopy, the patient was discharged home on day 34. The fecaloma completely resolved after the seventh colonoscopic fragmentation on day 44. Sixteen months after treatment, there is no evidence of recurrent fecaloma. According to the literature, risk factors for fecaloma after colectomy include female gender, left-side colonic anastomosis, and FEEA. FEEA might not be recommended for anastomoses in the left colon, particularly in female patients, to avoid this complication. Colonoscopic fragmentation is recommended for fecalomas at an anastomotic site after colectomy in patients without an absolute indication for surgery.
