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Gastroenterol Rep (Oxf). 2016 Nov;4(4):334-336. Epub 2015 Jul 10.

Computed tomography-guided endoscopic needle knife therapy for ileal pouch sinus.

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Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA and.
Center for Inflammatory Bowel Diseases, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA


Ileal pouch-anal anastomosis surgery can be complicated by anastomotic leaks, leading to the formation of abscess and chronic sinus that have been routinely managed by a surgical approach. We developed the endoscopic needle knife sinusotomy (NKSi) technique, which has become a valid alternative. The basic principle of endoscopic NKSi is dissection and drainage of the sinus through its orifice internally into the lumen of pouch body. The success of NKSi requires an access to the sinus from the pouch side. One of the most challenging situations for NKSi is a closed orifice of the sinus, which leaves an isolated chronic abscess cavity. Here we report a case of complicated presacral sinus with a closed orifice that was not amenable to NKSi, necessitating a CT-guided guide wire placement and subsequent NKSi.


anastomotic leak; computed tomography; endoscopic needle knife sinusotomy; ileal pouch-anal anastomosis; presacral sinus

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