Post written by Jun Takada, MD, PhD, from the Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan.

This video case is about a 62-year-old man who developed an obstruction in the anastomotic region 6 months after Hartmann’s surgery for rectal cancer.

Colonoscopies performed through the anal and ileal stoma showed complete anastomotic obstruction in the rectum. Fluoroscopy revealed that the obstruction length was less than 1 cm. We used 2 scopes, 1 inserted from the anal side (the retrograde approach) and the other from the ileostomy (an antegrade fashion), to facilitate guidance and observation from the oral side of the obstruction. An assistant introduced a scope from the oral side to the center of the obstruction, and the surgeon performed fenestration from the anal side using an electrosurgical knife under the transmitted light from the oral scope.

After penetrating the obstruction, the hole was enlarged by cutting the fibrous tissue concentrically under endoscopic guidance to secure the safest possible area for incision. Subsequently, balloon dilation was performed to a diameter of 16 mm, and the anastomotic region was enlarged to facilitate easy passage of the scope.

In this report, we describe a case of successful endoscopic fenestration using a novel anterograde-retrograde approach combined with the endoscopic rendezvous technique. We performed fenestration and enlarged the hole under endoscopic guidance to ensure the safest possible area for incision.

In conclusion, endoscopic fenestration under dual endoscopic view for correcting benign complete anastomotic obstruction occurring as a complication of rectal surgery can be an alternative to other procedures, such as the EUS-guided approach.

Endoscopic and fluoroscopic images obtained before the procedure. A, Endoscopic image from the anal side showing obstruction of the anastomotic region. B, Endoscopic image from the oral side.

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