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Case Reports: Unusual presentation of more common disease/injury
Blind loop mucocele of a side-to-end colorectal anastomosis as a rare cause of large bowel obstruction
  1. Luke Philip Edward Peacock1,2,
  2. Anang Pangeni2,
  3. Ashish Shrestha2 and
  4. Veera J Allu2
  1. 1St George's, University of London, London, UK
  2. 2General Surgery, William Harvey Hospital, Ashford, UK
  1. Correspondence to Luke Philip Edward Peacock; luke.peacock{at}nhs.net

Abstract

Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. To our knowledge, LBO due to blind colonic limb mucocele of a side-to-end colorectal anastomosis has not yet been described. We report a man in his late 50s presenting with pain, abdominal distension and constipation. He had extensive surgical history; notably, a side-to-end colorectal anastomosis was fashioned following Hartmann-type colostomy reversal. CT and MRI suggested a mucus-filled short blind colonic segment compressing the anastomotic site and causing LBO. Flexible sigmoidoscopy under general anaesthesia showed external rectal compression and lumen narrowing. Transrectal needle aspiration of the blind segment yielded 145 mL of mucoid fluid. The patient’s symptoms improved and he was discharged with outpatient Gastrografin enema and flexible sigmoidoscopy which confirmed successful blind segment emptying. This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction, and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.

  • General surgery
  • Surgery
  • Gastrointestinal surgery

http://dx.doi.org/10.1136/bcr-2022-253103

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    Footnotes

    • Contributors LPEP was the lead author for this case report and wrote the majority of the manuscript. AP was involved in the patient’s care and management and contributed to the writing, creating diagrams of the pathology and reviewing of this manuscript. AS led the clinical management of this patient and contributed to the writing and reviewing of this manuscript. VJA led the clinical management of this patient and contributed to the writing and reviewing of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.