Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul;14(3):285-8.
doi: 10.5217/ir.2016.14.3.285. Epub 2016 Jun 27.

High grade anorectal stricture complicating Crohn's disease: endoscopic treatment using insulated-tip knife

Hyung Ku Chon  1 , Ik Sang Shin  1 , Sang Wook Kim  1 , Soo Teik Lee  1
Affiliations

High grade anorectal stricture complicating Crohn's disease: endoscopic treatment using insulated-tip knife

Hyung Ku Chon et al. Intest Res. 2016 Jul.

Abstract

Endoscopic treatments have emerged as an alternative to surgery, in the treatment of benign colorectal stricture. Unlike endoscopic balloon dilatation, there is limited data on endoscopic electrocautery incision therapy for benign colorectal stricture, especially with regards to safety and long-term patency. We present a case of a 29-year-old female with Crohn's disease who had difficulty in defecation and passing thin stools. A pelvic magnetic resonance imaging scan, gastrograffin enema, and sigmoidoscopy showed a high-grade anorectal stricture. An endoscopic insulated-tip knife incision was successfully performed to resolve the problem. From our experience, we suggest that endoscopic insulated-tip knife treatment may be a feasible and effective modality for patients with short-segment, very rigid, fibrotic anorectal stricture.

Keywords: Anorectal stricture; Crohn diseases; Endoscopic insulated-tip knife.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1
Fig. 1. Pelvic MRI finding. Axial (A) and coronal (B) T2-weighted MR image demonstrated circumferential and short segment stricture of anorectal area (arrow in A and B).
Fig. 2
Fig. 2. Gastrograffin enema finding. It showed high-grade anorectal stricture, a segment about 1.4 cm in size.
Fig. 3
Fig. 3. Endoscopic findings of anorectal stricture (A) Initial sigmoidoscopy, showing a luminal stricture with fibrotic tissue and exudate except for two tiny holes (1-mm [black arrow] and 5-mm [white arrow]) (B, C) The fibrotic tissue near the 1 mm hole was removed via hot biopsy and widened to about 1 cm. (D) Endoscopic electrocautery incision using an insulated-tip knife through the widened hole was carried out between the 1-cm and 5-mm hole (E) Stricture area was widened (F) Follow-up sigmoidoscopy after 1 year.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Brochard C, Siproudhis L, Wallenhorst T, et al. Anorectal stricture in 102 patients with Crohn's disease: natural history in the era of biologics. Aliment Pharmacol Ther. 2014;40:796–803. - PubMed
    1. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn's disease complicated by strictures: a systematic review. Gut. 2013;62:1072–1084. - PMC - PubMed
    1. Krieger BR, Steinhagen RM. Perianal Crohn's disease - A surgical perspective. Semin Colon Rectal Surg. 2012;23:125–129.
    1. Keighley MR, Allan RN. Current status and influence of operation on perianal Crohn's disease. Int J Colorectal Dis. 1986;1:104–107. - PubMed
    1. Brooker JC, Beckett CG, Saunders BP, Benson MJ. Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series. Endoscopy. 2003;35:333–337. - PubMed

LinkOut - more resources