PO Box 2345, Beijing 100023, China World J Gastroenterol 2004;10(23):3534-3536 Fax: +86-10-85381893 World Journal of Gastroenterology E-mail: wjg@wjgnet.com www.wjgnet.com Copyright © 2004 by The WJG Press ISSN 1007-9327 • BRIEF REPORTS • Successful management of a benign anastomotic colonic stricture with self-expanding metallic stents: A case report Yong-Song Guan, Long Sun, Xiao Li, Xiao-Hua Zheng Yong-Song Guan, Long Sun, Xiao Li, Xiao-Hua Zheng, Department of Radiology Huaxi Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China Correspondence to: Dr. Yong-Song Guan, Department of Radiology, Huaxi Hospital, Sichuan University, 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China. yongsongguan@yahoo.com Telephone: +86-28-85421008 Fax: +86-28-85421008 Received: 2004-02-11 Accepted: 2004-02-21 Abstract AIM: To assess the effectiveness of and complications associated with metallic stent placement for treatment of anastomotic colonic strictures. METHODS: A 46-year-old man underging two procedures of surgery for perforation of descending colon due to a traffic accident presented with pain, abdominal distention, and inability to defecate. Single-contrast barium enema radiograph showed a severe stenosis in the region of surgical anastomosis and the patient was too weak to accept another laparotomy. Under fluoroscopic and endoscopic guidance, we placed two metallic stents in the stenosis site of the anastomosis of the patient with anastomotic colonic strictures. RESULTS: In this case of postsurgical stenosis, the first stent relieved the symptoms of obstruction, but stent migration happened on the next day so an additional stent was required to deal with the stricture and relieve the symptoms. CONCLUSION: This case confirms that metallic stenting may represent an effective treatment for anastomotic colonic strictures in the absence of other therapeutic alternatives. Guan YS, Sun L, Li X, Zheng XH. Successful management of a benign anastomotic colonic stricture with self-expanding metallic stents: A case report. World J Gastroenterol 2004; 10(23): 3534-3536 http://www.wjgnet.com/1007-9327/10/3534.asp INTRODUCTION Self-expandable metallic stent treatment for colorectal diseases was falling behind that for other organs. Recently, however, there have been many reports on the use of self-expanding metallic stents in colorectal diseases, mainly from the West. Self-expanding metallic stent is generally used as a palliative treatment for malignant strictures of the colon and rectum and before bridge as a surgery for obstructing colorectal cancers [1-3] . Some investigators have reported on the usefulness of self- expanding metallic stents for strictures of benign diseases [4,5] . Management of narrow (<5-mm) colonic anastomotic stricture mainly is performed endoscopically by repeated balloon dilation, often ineffectively [6] . The use of metallic self- expanding stents in malignant and benign strictures of the large bowel has been suggested only recently, and is still being debated [7,8] . In this report we proposed a single-stage procedure that we developed to manage narrow anastomotic colonic strictures. CASE REPORT A 46-year-old man underging two procedures of surgery for perforation of descending colon due to a traffic accident presented with pain, abdominal distention, and inability to defecate. Single- contrast barium enema radiograph showed a severe stenosis in the region of surgical anastomosis. The patient was too weak to accept another laparotomy. He reached us with a significant stricture of the descending colon anastomoses (smaller than 5 mm in diameter). With the patient in supine position and two knee joints reflexing, a catheter was inserted over a hydrophilic guide- wire through the anus to the lesion targeted under fluoroscopic and endoscopic guidance. An 85-cm 6-F catheter (Cook) and a 180-cm 0.35-inch guide wire (Bard) were used. The guide wire was maneuvered passing the stricture and the catheter was advanced. This guide wire was then replaced with another guide wire (Amplatz super stiff Guide Wire) for stent delivery and insertion. The stent was then positioned precisely across the lesion and released. The symptoms were released immediately, but on the next day the patient manifested abdominal distention, and inability to defecate. Anteroposterior radiographs from a follow-up barium study showed the stent migrated and a second stent was needed. The second stent was deployed with the same stent placement techniques. Radiographs obtained after a water-soluble enema on the day after the second stent deployed showed that the stents expanded to provide an adequate lumen (Figures 1-4). The first coated stent (Nanjing MicroTech, China) was 12-cm in length, 32-mm in diameter. The second uncoated stent (Nanjing MicroTech, China) was 20-cm in length, 32-mm in diameter. At the time of this writing, ie, 18 mo of follow-up evaluation, the patient could defecate without any difficulty. Figure 1 Stenosis at the segment of descending colon, less than 5 mm in diameter.