Laser lithotripsy for the treatment of a giant fecalith obstructing a colorectal anastomosis.

Abstract

A 77-year-old women who had undergone surgical resection of a sigmoid cancer 27 years previously was evaluated for symptoms suggestive of bowel obstruction. A computed tomography (CT) scan showed a 36-mm dense rounded mass in the colon on the oral side of a stenotic colorectal anastomosis ([Fig. 1]; [Video 1]). At colonoscopy, the colorectal anastomosis, which had a 6-mm opening ([Fig. 2 a]), was dilated before the mass could be seen ([Fig. 2 b]). Lithotripsy using Holmium laser (Dornier) was started ([Fig. 2 c]) and multiple cavities were made in an attempt to weaken and divide the stone prior to mechanical lithotripsy ([Fig. 2 d]). During attempts to fragment the stone, nine mechanical lithotripters (Olympus) were damaged and this was followed by failure of the emergency lithotripter handle when trying to resolve the problem. Damaged wires impacted in the fecalith had to be divided by laser to separate the lithotripter from the stone. The stone was finally attenuated sufficiently to be fragmented and, after the anastomosis had been dilated to 18 mm, the larger segments were eventually cleared.