ANASTOMOTIC OCCLUSIVE WEB FOLLOWING DOUBLE-STAPLED ANTERIOR RESECTIONAND FECAL DIVERSION - PRESENTATION AND ENDOSCOPIC MANAGEMENT

The incidence of occlusive web following stapled anastomosis for curat ive resection of rectal cancer is unknown and the management of this e ntity not well defined. A 73-year-old patient underwent a double-stapl ed anterior resection with a temporary loop ileostomy for a T3,N1 rect al cancer. He received postoperative chemoradiation adjuvant therapy. Prior to ileostomy closure, sigmoidoscopy revealed an anastomotic occl usive web at 10-12 cm from the anal verge. Under monitored sedation, a flexible sigmoidoscope was inserted per anus and advanced to the leve l of the occlusive web. Utilizing hydrostatic balloon dilatation, the occlusive web was broken and the bowel lumen was restored. The procedu re was performed expeditiously and without complications. Subsequently the patient underwent ileostomy closure and experienced normal bowel movements. Although occlusive webs are uncommon after colorectal anast omosis, this case report describes a safe, effective, and uncomplicate d endoscopic procedure that can be performed in patients with anastomo tic occlusive web developing after prolonged fecal diversion.