Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 6086-6094
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6086
Endoscopic fenestration in the diagnosis and treatment of delayed anastomotic submucosal abscess: A case report and review of literature
Bao-Zhen Zhang, Yi-Dan Wang, Ye Liao, Jing-Jing Zhang, Yu-Fan Wu, Xiao-Lin Sun, Si-Yu Sun, Jin-Tao Guo
Bao-Zhen Zhang, Yi-Dan Wang, Ye Liao, Jing-Jing Zhang, Yu-Fan Wu, Si-Yu Sun, Jin-Tao Guo, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Xiao-Lin Sun, Department of Endoscopy Center, Liaoyang Liaohua Hospital, Liaoyang 111000, Liaoning Province, China
Author contributions: Zhang BZ, Wang YD, Liao Y, Zhang JJ, Wu YF, Sun XL, Sun SY, and Guo JT were involved in diagnostic flow, patient follow-up, data collection, and literature review; Zhang BZ contributed to interpretation of the published data and drafting of the manuscript; Guo JT was the endoscopic operator; Guo JT and Sun SY performed critical revision of the article for important intellectual content; all the authors read and gave their final approval of the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81900601; University Innovation Team and Innovative Talent Support Program of Liaoning Province, No. LR2019073; and Outstanding Scientific Fund of Shengjing Hospital, No. 201702.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE checklist (2016), and the manuscript was prepared and revised according to the CARE checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Tao Guo, MD, PhD, Doctor, Professor, Research Fellow, Department of Gastroenterology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. guojt@sj-hospital.org
Received: June 1, 2020
Peer-review started: June 1, 2020
First decision: September 13, 2020
Revised: September 28, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 6, 2020
Processing time: 185 Days and 20 Hours
Abstract
BACKGROUND

Abscess formation is one of the complications after radical resection of rectal cancer; cases with delayed postoperative anastomotic abscess are rare. Here, we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery. Ultimately, the patient was diagnosed and treated by endoscopic fenestration. In addition, we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.

CASE SUMMARY

A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma. Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria, and a submucosal tumor was suspected. The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography, which revealed no thickening or strengthening of the anastomotic wall. In order to clarify the origin of the lesion and obtain the pathology, endoscopic fenestration was performed. After endoscopic procedure, a definitive diagnosis of delayed anastomotic submucosal abscess was established. The patient achieved good recovery and prognosis after the complete clearance of abscess.

CONCLUSION

Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.

Keywords: Anastomotic stoma; Rectal cancer; Submucosal tumor; Endoscopic fenestration; Delayed postoperative abscess; Case report

Core Tip: Delayed postoperative abscess is a rare complication after radical resection of rectal cancer, especially those presenting several years after surgery. Here, we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing who was treated by endoscopic fenestration. In addition, we review the literature on abscess after rectal cancer surgery. Although extremely rare, delayed submucosal abscess should be considered in the differential diagnosis in cases with suspected submucosal tumors in patients after rectal cancer resection with intestinal smooth swelling. Meanwhile, endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal postoperative smooth protuberance.