Techniques in Coloproctology (2018) 22:379–381 https://doi.org/10.1007/s10151-018-1794-1 TRICK OF THE TR ADE Sequential endoscopic and surgical removal of giant rectal adenomas extending to the dentate line 1 2 1 1 A. Rickenbacher · P. Bauerfeind · F. Rössler · M. Turina Received: 5 February 2018 / Accepted: 5 May 2018 / Published online: 1 June 2018 © Springer International Publishing AG, part of Springer Nature 2018 Introduction adenomatous tissue. The submucosal defect reepithelializes and is checked for complete healing after 3 weeks (Fig. 1c) Large tubulovillous adenomas (TVA) in the low rectum that prior to the LAR/TME, which will then allow complete extend to or beyond the dentate line are a rare but challeng- removal of the remaining adenoma tissue (Fig. 2b). ing entity. Complete endoscopic resection is often not feasi- ble. In this situation, abdominoperineal resection with end Case 1 colostomy is the classic alternative to achieve an oncologi- cally safe resection. For benign disease however, this repre- A 63-year-old healthy female presented with rectal bleeding. sents an operation with a major long-term impact on quality The subsequent colonoscopy revealed a giant adenoma in the of life. In this report, we propose a hybrid technique using lower rectum with low-grade dysplasia. The tumor extended endoscopic submucosal dissection (ESD) of the lower part
Techniques in Coloproctology – Springer Journals
Published: Jun 1, 2018
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