Management of obliterating stricture after coloanal anastomosis.

We present an unconventional approach to the management of a severe stricture with complete luminal obliteration after a coloanal anastomosis which was protected with a diverting loop ileostomy. The colonoscope was inserted in an antegrade fashion into the defunctionalized limb of the loop ileostomy and advanced to the level of the stricture. Under colonoscopic vision, a Kelly clamp was carefully introduced transanally through the stricture into the proximal lumen. The strictured anastomosis was then dilated with calibrated Hegar dilators. Periodic dilatations followed by closure of the ileostomy completed the management. The technique obviated the need for a more extensive surgical procedure.