Postoperative Strictures and Suture Granulomas

Postoperative strictures. Postoperative strictures are commonly observed in the anastomosed region of the lower rectum after rectal resection. They are occasionally the result of dehiscence after resection of very low rectal carcinomas. Therapy with balloon dilation can help dilate the stricture. Dilation should be performed step-by-step in intervals of three to four days (balloon diameter: 15-25 mm). Intestinal resection in Crohn disease can also lead to inflammatory stenosis or scarring (Fig. 17.2), the latter of which is endoscopically treatable with balloon dilation, if a shorter bowel segment is affected.

Suture granulomas. The surface of the often-granulated mucosa is smooth so that it is unlikely that a suture granuloma will be mistaken for a sessile polyp or early carcinoma, even based on visible appearances alone. If there is any doubt, a biopsy should be performed. Sometimes suture remnants are visible (Fig. 17.3).

Fig. 17.3 Suture granulomas. Three dark suture granulomas at the anastomosis after sigmoid resection (not clinically relevant).

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