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- W2977430734 abstract "FigureIntroduction: This case report involves a 40 year old male with ulcerative colitis status post restorative proctocolectomy with ileal pouchanal anastomosis. Post-operative complications included pouch torsion and anastomotic leak necessitating a diversion loop ileostomy and pouch revision with end-to-end ileum to pouch anastomosis. Prior to planned ileostomy takedown, contrast studies and pouchoscopy demonstrated complete obstruction at the anastomosis. Patient was referred for endoscopic therapy. Methods: Simultaneous insertion of gastroscopes into the ileostomy and pouch demonstrated an obstructive thin membrane at the anastomosis. Transillumination across the obstruction was utilized to identify the lumen of the anastomosis. After insertion of a 19 gauge endoscopic ultrasound needle through the membrane, serial balloon dilations were performed. Results: Following dilation, both gastroscopes were successfully passed across the anastomosis. No evidence of bleeding, perforation or dehiscence was observed at end of procedure. No peri-procedural complications occurred. Post-procedure contrast study at 1 week demonstrated no evidence of obstruction. Intra-operative ileoscopy and pouchoscopy demonstrated patent surgical anastomosis. Subsequent successful ileostomy takedown was performed with patient asymptomatic at 1 month follow-up. Conclusion: Diaphragm disease (DD) manifests as the development of circumferential mucosal membranes that occlude intestinal lumen and may lead to strictures or complete obstruction. This rare condition is most commonly associated with non-steroidal anti-inflammatory drug (NSAID) use. Resection is the most common therapy. This is the first reported case of DD involving an ileum to pouch anastomosis. Additionally, the patient has no prior NSAID exposure. This case demonstrates that utilization of bidirectional endoscopies with transillumination and dilation is a feasible, safe, and effective method to re-establish lumen patency in small bowel obstructions secondary to luminal diaphragms." @default.
- W2977430734 created "2019-10-10" @default.
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- W2977430734 date "2015-10-01" @default.
- W2977430734 modified "2023-09-27" @default.
- W2977430734 title "Endoscopic Dilation of an Anastomotic Diaphragm in Ulcerative Colitis: A Case Report" @default.
- W2977430734 doi "https://doi.org/10.14309/00000434-201510001-01608" @default.
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