Stricture anastomotic

Said M, Mekki M, Golli M, Memmi F, Hafsa C, Braham R et al (2003) Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. Br J Radiol 76 26-31... 

Fig. 22.8a,b. Stenosis of hepaticojejunostomy. Coronal oblique MIP 3D heavily T2-weighted MR cholangiogram (a) and MR VR enlargement (b) accurately depict an anastomotic stricture (arrow) with marked dilation of the pre-anastomotic extra and intrahepatic biliary systems... 

Acute obstruction of the colon and rectum is caused by a number of benign and malignant diseases but by far the most frequent aetiology is colorectal carcinoma (Parker et al. 1997 Deans et al. 1994). Other maUg-nant causes include infiltration from adjacent mahg-nant tumour and metastatic involvement. Benign conditions such as diverticuhtis or other inflammatory bowel diseases (Crohn s disease, tuberculosis) and anastomotic or post-irradiation strictures are less frequent (Cascales-Sanchez et al. 1997 Rodier et al. 1987 De Lange and Shaffer 1991). 

Stent fracture in the colon and rectum seems to be a rare event and has only been described in connection with one particular stent design. Odurny et al. (2001) described three cases in which Memotherm nitinol stents were found to be fractured after 3,6 and 7 months. All patients had originally been treated for recurrent anastomotic strictures, one of which was due to local tumour recurrence. This type of nitinol stent does seem unsuitable for long-term management of strictures in the gastrointestinal tract since fracture of Memotherm stents has also been reported in the biliary tract (Peck and Wattam 2000). 

Cornud F, Lefebre J, Chretien Y et al. (1988) Percutaneous transrenal electro-incision of ureter-intestinal anastomotic strictures comparison of open surgical and endourologi-cal repair. J Urol 139 1195-1198... 

MSCs in ring-shaped 3D hydrogels. These hydrogels were implanted into rats. The negative outcome (only three animals survived for 24 h and died the next day), due to strictures in the anastomotic regions, was mainly associated with the lack of an epithelial layer. 

V. Janik, L. Horak, J. Hnanicek, J. Malek, and H.-U. Laasch, Biodegradable polydioxanone stents a new option for therapy-resistant anastomotic strictures of the colon, Eur. Radiol, 21 (9), 1956-1961, Sep. 2011. 

Fig. 4.1.6. Apparent anastomotic biliary stricture due to donor-to-recipient bile duct diameter discrepancy...

Non-anastomotic biliary strictures occur secondary to hepatic artery thrombosis or stenosis, preservation injury, ABO blood group incompatibility, and chronic ductopenic rejection. They are frequently multiple. Isolated non-anastomotic strictures of the donor extra-hepatic or intra-hepatic biliary tree may... 

Strictures can occur at the anastomotic site, where they are caused by scar tissue, or at non-anastomotic sites, where they are most often secondary to ischemia caused by hepatic arterial lesions (Quiroga et al. 1991). 

Fig. 4.2. 25. Bile duct anastomotic stricture. A 37-year-old female status post fulminant acute hepatitis A, followed by orthotopic cadaveric liver transplant presenting now with abnormal liver function tests. Coronal thick-slab T2-weighted single-shot fast spin echo (SSFSE) MRCP image shows a short-segment stenosis (arrow) at the biliary anastomosis with upstream dilatation of the common bile duct. The remnant of the cystic duct (arrowhead) and a small amount of hyperintense fluid in the duodenal lumen (asterisk) are also seen...

MRCP is helpful in the detection of biliary strictures, bile leaks, and biloma formation. Thick-slab MRCP images are particularly useful in the presence of biliary dilatation (Fig. 4.2.25). However, proximal biliary dilatation may be absent in the transplanted patient with stenosis at the anastomotic site (Laghi et al. 1999 Pandharipande et al. 2001). Careful analysis of thin-slice MR images can help to identify the stricture and/or leak (Fig. 4.2.26). False MR positive and negative results may occur in the presence of surgical clips due to susceptibility artifact obscuring the biliary ducts. 

Non-anastomotic biliary strictures and dilations are the result of ischemic insults to the bile ducts only within the graft (Boraschi et al. 2004). Non-anastomotic strictures are probably the result of microcirculatory problems and they usually... 

The most common airway problems are anastomotic dehiscence and bronchial stenosis due to strictures. The reason is mostly a lack of perfusion of the bronchial tree, as the donor airways depend on a retrograde pulmonary-to-bronchial arterial circulation until revascularization of the bronchus wall occurs. Ischaemia is greater on the right main bronchus than on the left, therefore anastomotic healing is better on the left and early stenotic problems or dehiscence occur on the right anastomosis more frequently than on the left side. In the early years of transplantation the en bloc technique was mainly performed with a high incidence of tracheal dehiscence, which prompted the development of bilateral lung transplantation. 

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