A Rare Case of Colorectal Complete Anastomotic Stenosis Treated by TEM

Aims: Since the introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in 2004, it has attracted a great deal of interest from surgeons. Transanal Endoscopic Microsurgery (TEM) is a type of NOTES, developed by Buess for rectal tumors, and utilized also to treat other rectal diseases. We achieved a wide experience utilizing TEM to treat rectal disorders such as recto-vaginal fistula, recto-vesical fistula, GIST, etc. We describe a rare postoperative complication solved by transanal approach by TEM. This is an original contribution because after a revision of the literature no other similar cases were described Methods: We present the case of a 36 year-old woman who presented with intermittent abdominal distention, pain and constipation. After Hirschprung Disease was diagnosed, the patient was submitted to a modified Duhamel operation and ileostomy. A postoperative barium enema control showed a complete stricture of the anastomosis. It was impossible to resolve the stricture by flexible endoscopic approach, because no orifice could be detected by the endoscopist. Then an intraoperative endoscopic approach to facilitate the localization of pre-anastomotic colon was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM. Results: The patient underwent a control barium enema on 30th POD, showing regular retrograde transit of contrast medium without evidence of stenosis. She underwent a surgical operation for the closure of the ileostomy with regular restoration of intestinal canalization. Conclusions: Transanal approach by TEM is safe and feasible and represents a model of NOTES which can be applied even to a wide range of applications.