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Background and Aims: While the occurrence of colonic stricture in Crohn’s disease (CD) always raises concerns about the risk of cancer, the neoplastic risk associated with its stricture remains poorly known. Methods: All consecutive patients with colorectal stricture complicating CD in 3 academic centers between 1993 and 2022 were included in a retrospective cohort. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes. Factors associated with neoplastic stricture were investigated by logistic regression. Results: A total of 88 patients (median age, 25 [interquartile range {IQR}, 19–37] years and median disease duration 12 [4–19] years) with 96 colorectal strictures were included. Strictures were nonpassable by the scope in 61.4% (n = 54) of cases, 70.5% (n = 62) were ulcerated, and 62.5% (n = 55) were symptomatic. Colonic resection and endoscopic balloon dilatation were needed in 47.7% (n = 42) and 28.6% (n = 12) of patients, respectively. After a median follow-up of 21.5 months (IQR [5.5–46.5]), 7 (8%) patients were diagnosed with neoplasia at the colonic stricture site (colonic adenocarcinoma, n = 5; neuroendocrine carcinoma, n = 1; and B-cell lymphoproliferative neoplasia, n = 1), with a median stricture duration at colorectal neoplasia diagnosis of 0 month (IQR [0.0–5.5]). While neoplastic strictures were diagnosed in older patients (58 vs 39 years), with longer disease duration (18 vs 11 years) and frequent obstructive symptoms (57.1% vs 11.1%), no patient-related or stricture-related factor was associated with neoplastic stricture in multivariate analysis. Conclusion: Eight percent of patients with colonic stricture complicating CD developed colorectal cancer. Colorectal cancer and stricture were often diagnosed at the same time and we did not report malignant stricture after 1 year of follow-up.

Abstract Background The status of anastomotic blood perfusion is associated with the occurrence of anastomotic leakage after intestinal anastomosis. Fluorescence angiography (FA) with indocyanine green (ICG) can objectively assess intestinal blood perfusion. This study aims to investigate whether anastomotic perfusion assessment with ICG influences surgical decision-making during laparoscopic intestinal resection and primary anastomosis for colonic stricture after necrotizing enterocolitis. Methods Patients who underwent laparoscopic intestinal resection and primary anastomosis between January 2022 and December 2022 were retrospectively analyzed. Before intestinal anastomosis, the ICG fluorescence technology was used to evaluate the blood perfusion of intestinal tubes on both sides of the anastomosis. After the completion of primary anastomosis, the anastomotic blood perfusion was assessed again. Results Of the 13 cases, laparoscopy was used to determine the extent of the diseased bowel to be excised, and the normal bowel was preserved for anastomosis. The anastomosis was established under the guidance of ICG fluorescence technology, and FA was performed after anastomosis to confirm good blood flow in the proximal bowel. The anastomotic intestinal tube was changed in one case because FA showed a difference between the normal range of intestinal blood flow and the macroscopic prediction. There was no evidence of ICG allergy, anastomotic leakage, anastomotic stricture, or other complications. The median follow-up was 6 months, and all patients recovered well. Conclusions The ICG fluorescence technology is helpful in precisely and efficiently determining the anastomotic intestinal blood flow during stricture resection and in avoiding anastomotic leakage caused by poor anastomotic intestinal blood flow to some extent, with satisfactory short-term efficacy.

Introduction: Eosinophilic colitis (EC) is an uncommon inflammatory condition with the lowest reporting rate among eosinophilic gastrointestinal disorders. EC, which is characterized by the accumulation of eosinophilic cells, is typically diagnosed by a combination of clinical, imaging, and microscopic evaluations. We present a rare case of complete colonic obstruction due to eosinophilic colitis (EC) in a neonate, which was successfully managed with surgical intervention. Case presentation: A 27-day-old female neonate presented with bloody diarrhea and anemia, followed by repeated bilious vomiting, feeding intolerance, and abdominal distention along with very limited bowel motion. Abdominal radiography showed contrast-medium retention in the colon with persistent bowel dilatation while a lower GI contrast enema indicated a cut-off sign at the level of the sigmoid colon. Subsequent colonoscopy revealed a rectosigmoid stricture with complete luminal obstruction 7 cm from the anal verge. Histopathological examination showed marked eosinophilic infiltration through all the layers of the colon. Exploratory laparotomy showed a 3-cm complete stricture with severe gross inflammation in the rectosigmoid colon. Resection of the affected segment and primary anastomosis was achieved successfully, and the patient showed an uneventful recovery with no symptoms at discharge as well as age-appropriate weight gain at the one-year follow-up examination. Conclusion: To our knowledge, this is the first reported case of rectosigmoid stricture caused by EC in a neonate, and it highlights the importance of including EC in the differential diagnosis of colonic obstruction in neonates as well as the need for surgical management in such cases.

Background: The status of anastomotic blood perfusion is associated with the occurrence of anastomotic leakage after intestinal anastomosis. Fluorescence angiography (FA) with indocyanine green (ICG) can objectively assess intestinal blood perfusion. This study aims to investigate whether anastomotic perfusion assessment with ICG influences surgical decision-making during laparoscopic intestinal resection and primary anastomosis for colonic stricture after necrotizing enterocolitis. Methods: Patients who underwent laparoscopic intestinal resection and primary anastomosis between January 2022 and December 2022 were retrospectively analyzed. Before intestinal anastomosis, the ICG fluorescence technology was used to evaluate the blood perfusion of intestinal tubes on both sides of the anastomosis. After the completion of primary anastomosis, the anastomotic blood perfusion was assessed again. Results: Of the 13 cases, laparoscopy was used to determine the extent of the diseased bowel to be excised, and the normal bowel was preserved for anastomosis. The anastomosis was established under the guidance of ICG fluorescence technology, and FA was performed after anastomosis to confirm good blood flow in the proximal bowel. The anastomotic intestinal tube was changed in one case because FA showed a difference between the normal range of intestinal blood flow and the macroscopic prediction. There was no evidence of ICG allergy, anastomotic leakage, anastomotic stricture, or other complications. The median follow-up was 6 months, and all patients recovered well. Conclusions: The ICG fluorescence technology is helpful in precisely and efficiently determining the anastomotic intestinal blood flow during stricture resection and in avoiding anastomotic leakage caused by poor anastomotic intestinal blood flow to some extent, with satisfactory short-term efficacy. [ABSTRACT FROM AUTHOR]

Ultraselective transcatheter arterial embolization with microcoils is a highly effective and safe treatment for lower gastrointestinal bleeding. Here we present a patient with a history of pandiverticulosis, who was hospitalized with acute hemorrhage in the mid-transverse colon. The patient underwent a successful embolization with a microcatheter and microcoils. Postembolization angiography demonstrated no residual flow to the areas of concern. One-month postembolization, however, the patient presented to the emergency department with nonspecific abdominal symptoms. After imaging and endoscopy studies, a colonic stricture–a rare complication of ultraselective embolization with microcoils– was found. The patient underwent partial colectomy of the mid-transverse colon; postcolectomy course was uneventful. The case suggests a rare but clinically significant complication of ultraselective embolization using microcoils for patients with diverticular hemorrhage. We therefore hope to assist clinicians in making the appropriate diagnosis and intervention when presented with similar clinical presentations and history of embolization.

Background and Aims: While the occurrence of colonic stricture in Crohn's disease (CD) always raises concerns about the risk of cancer, the neoplastic risk associated with its stricture remains poorly known., Methods: All consecutive patients with colorectal stricture complicating CD in 3 academic centers between 1993 and 2022 were included in a retrospective cohort. We collected clinical, endoscopic, surgical, and pathology data and information on outcomes. Factors associated with neoplastic stricture were investigated by logistic regression., Results: A total of 88 patients (median age, 25 [interquartile range {IQR}, 19-37] years and median disease duration 12 [4-19] years) with 96 colorectal strictures were included. Strictures were nonpassable by the scope in 61.4% (n = 54) of cases, 70.5% (n = 62) were ulcerated, and 62.5% (n = 55) were symptomatic. Colonic resection and endoscopic balloon dilatation were needed in 47.7% (n = 42) and 28.6% (n = 12) of patients, respectively. After a median follow-up of 21.5 months (IQR [5.5-46.5]), 7 (8%) patients were diagnosed with neoplasia at the colonic stricture site (colonic adenocarcinoma, n = 5; neuroendocrine carcinoma, n = 1; and B-cell lymphoproliferative neoplasia, n = 1), with a median stricture duration at colorectal neoplasia diagnosis of 0 month (IQR [0.0-5.5]). While neoplastic strictures were diagnosed in older patients (58 vs 39 years), with longer disease duration (18 vs 11 years) and frequent obstructive symptoms (57.1% vs 11.1%), no patient-related or stricture-related factor was associated with neoplastic stricture in multivariate analysis., Conclusion: Eight percent of patients with colonic stricture complicating CD developed colorectal cancer. Colorectal cancer and stricture were often diagnosed at the same time and we did not report malignant stricture after 1 year of follow-up., (© 2024 The Authors.)

Eosinophilic colitis (EC) is an uncommon inflammatory condition with the lowest reporting rate among eosinophilic gastrointestinal disorders. EC, which is characterized by the accumulation of eosinophilic cells, is typically diagnosed by a combination of clinical, imaging, and microscopic evaluations. We present a rare case of complete colonic obstruction due to eosinophilic colitis (EC) in a neonate, which was successfully managed with surgical intervention. A 27-day-old female neonate presented with bloody diarrhea and anemia, followed by repeated bilious vomiting, feeding intolerance, and abdominal distention along with very limited bowel motion. Abdominal radiography showed contrast-medium retention in the colon with persistent bowel dilatation while a lower GI contrast enema indicated a cut-off sign at the level of the sigmoid colon. Subsequent colonoscopy revealed a rectosigmoid stricture with complete luminal obstruction 7 cm from the anal verge. Histopathological examination showed marked eosinophilic infiltration through all the layers of the colon. Exploratory laparotomy showed a 3-cm complete stricture with severe gross inflammation in the rectosigmoid colon. Resection of the affected segment and primary anastomosis was achieved successfully, and the patient showed an uneventful recovery with no symptoms at discharge as well as age-appropriate weight gain at the one-year follow-up examination. To our knowledge, this is the first reported case of rectosigmoid stricture caused by EC in a neonate, and it highlights the importance of including EC in the differential diagnosis of colonic obstruction in neonates as well as the need for surgical management in such cases. [ABSTRACT FROM AUTHOR]

Haemolytic uraemic syndrome (HUS) is an infectious disease that can rapidly become life-threatening in the paediatric population. A number of long-term complications may arise from HUS including the rare development of colonic strictures. In this case report, we present two cases with similar presentations of colonic strictures following HUS. Case 1 is a 17-month-old female who developed HUS and multiple complications including a sigmoid colonic stricture. Once the stricture was resected, her recovery was rapid and complete. Case 2 is a 3-year-old male who developed severe HUS requiring dialysis. After developing a small bowel obstruction, a laparotomy demonstrated caecal disease, pan-colonic inflammation, a calcified appendix and a strictured descending colon. A second operation revealed strictures at the transverse, descending and sigmoid colon. Once the diseased part of bowel had been removed his recovery was complete. This report demonstrates the diagnostic difficulty and patient morbidity that may arise from post-HUS colonic strictures. A contrast study is the recommended investigation of choice in patients presenting with ongoing gastrointestinal symptoms after an acute infection with HUS.

Haemolytic uraemic syndrome (HUS) is an infectious disease that can rapidly become life-threatening in the paediatric population. A number of long-term complications may arise from HUS including the rare development of colonic strictures. In this case report, we present two cases with similar presentations of colonic strictures following HUS. Case 1 is a 17-month-old female who developed HUS and multiple complications including a sigmoid colonic stricture. Once the stricture was resected, her recovery was rapid and complete. Case 2 is a 3-year-old male who developed severe HUS requiring dialysis. After developing a small bowel obstruction, a laparotomy demonstrated caecal disease, pan-colonic inflammation, a calcified appendix and a strictured descending colon. A second operation revealed strictures at the transverse, descending and sigmoid colon. Once the diseased part of bowel had been removed his recovery was complete. This report demonstrates the diagnostic difficulty and patient morbidity that may arise from post-HUS colonic strictures. A contrast study is the recommended investigation of choice in patients presenting with ongoing gastrointestinal symptoms after an acute infection with HUS. [ABSTRACT FROM AUTHOR]

Although cytomegalovirus (CMV) is a common congenital infection in neonates, most patients are asymptomatic. Gastrointestinal manifestation is unusual. In this report, we described a newborn with perinatal CMV infection presented with symptoms mimicking necrotizing enterocolitis. We hope to alert clinicians about this possible diagnosis when managing newborn gastrointestinal diseases.

Existe una incidencia no despreciable de lesiones de colon de origen isquémico tras resecciones anteriores bajas por cáncer. Presentamos un caso de estenosis isquémica de colon, no relacionada con radioterapia, a los 5 años de la cirugía. Se discute la dificultad del diagnóstico diferencial con recidiva tumoral, así como el importante papel que desempeña la endoscopia en el abordaje de estos pacientes.A considerable incidence of colonic strictures after oncologic low anterior resections has been reported. The present paper describes a colonic stricture 5 years after the surgery, and not related to radiotherapy, that required a challenging differential diagnosis with local recurrence of rectal cancer. The role of endoscopy in the management of this condition is discussed.

Colo-duodenal fistula is an extremely rare complication of Crohn’s disease (CD) and most patients require surgical treatment. The common presentation of such cases is fecaloid vomiting and the diagnosis is generally made by upper GI endoscopy. The presence of an associated colonic stricture further supports the fact that the disease started in the colon and requires surgical management to alleviate the symptoms. Small fistulas can be occluded with fibrin glue or clipping by endoscope, whereas the larger fistulas require surgical management. The patient presented to us with features of acute intestinal obstruction and was already on anti-tubercular therapy for 4 months due to a suspicion of abdominal TB. On examination, a lump was palpable in the right hypochondrium along with palpable bowel loops. CT scan showed mesenteric lymphadenopathy along with a stricture in the transverse colon which was confirmed by colonoscopy. A provisional diagnosis of malignant stricture with intestinal obstruction with high probability of carcinoma colon coexisting with tuberculosis was made and the patient underwent extended right hemicolectomy with ileocolic anastomosis with two-layered duodenal wall closure supplemented with jejunal serosal patch. The histopathology report was suggestive of CD. Thus, in any patient presenting with recurrent abdominal colics, episodes of obstruction or abdominal tuberculosis not responding to ATT, a differential diagnosis of IBD must always be kept in mind. The incidence of IBD is slowly rising in India over the past two decades. [ABSTRACT FROM AUTHOR]

Entamoeba histolytica infection can lead to colitis, peri-colic abscess, ameboma, perforation and rarely colonic stricture. Amebic colitis is usually managed with medical management and rarely needs surgical management. We hereby report a case of colonic amebiasis, presenting as a stricture in transverse colon, mimicking malignancy, and managed successfully. [ABSTRACT FROM AUTHOR]

Abstract Objective Fibrosing colonopathy (FC) is a rare entity associated with cystic fibrosis (CF). Until now, patients with stricturing FC have usually been treated surgically. In this instance, we aimed at avoiding surgery by applying a new conservative approach. Methods Case report on an adult with CF who developed persistent abdominal pain due to a non-passable stricture in the right transverse colon. Histology confirmed fibrosing colonopathy. Results Initially we treated the patient with prednisolone pulse therapy and additive antibiotic therapy. For maintenance therapy we administered budesonide. The patient underwent clinical, laboratory and endoscopic follow-up over a three-year period. The stricture healed and was easy to pass. A relapse in the cecum at the ileocecal valve again improved under steroid and antibiotic therapy. Conclusions We present a novel therapeutic approach for advanced stricturing FC in an adult patient which successfully avoided surgery (right hemicolectomy) over a three year follow up.

Although cytomegalovirus (CMV) is a common congenital infection in neonates, most patients are asymptomatic. Gastrointestinal manifestation is unusual. In this report, we described a newborn with perinatal CMV infection presented with symptoms mimicking necrotizing enterocolitis. We hope to alert clinicians about this possible diagnosis when managing newborn gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.

We report the first case of trimming of a migrated metal colonic stent for stent induced severe anorectal pain. We present a case of a 54-year-old female with history of metastatic colorectal carcinoma who had stent placement secondary to obstruction. Subsequent distal migration of the stent caused ulcerations into the rectal mucosa and excruciating anorectal pain. We used argon plasma coagulation (APC) to successfully trim the exposed distal portion of the metal stent and rat tooth forceps to retrieve the stent fragments. The use of APC for trimming metallic stents is an effective procedure that can be used to trim migrated rectal stents that result in significant rectal pain. To date, few studies have been published that use APC to trim metallic stents placed in the gastrointestinal tract. To the best of our knowledge, ours is the only known case in which the indication for stent trimming was severe stent induced rectal pain. The procedure resulted in complete relief of patient symptoms. Therefore, APC is a safe and effective way to trim colo-rectal stents to definitively relieve the symptom of stent induced rectal pain in patients who have experienced distal stent migration and mucosal ulceration.