A common complication after having a bowel resection is the development of a stricture at the anastomotic (re-connection) site.

An anastomotic stricture is a narrowing, often from scarring, at the suture or staple line.  A stapled colorectal anastomosis is often associated with an increased risk of stricture formation compared with a hand-sewn one according to the research I found.

I had four major surgeries in nine months, one temporary end colostomy, one temporary loop ileostomy, both reversed, and all due to diverticulitis.  My final surgery was December 2017 and at that time, my surgeon checked for a stricture at the original re-connection site before he did the final reversal of the ileostomy.  He had used the stapler for that connection two months earlier. All looked great.

About six months later, I started to notice a slight difference when I went to the bathroom.  It was subtle at first, just a slight pressure on my left side and I really didn’t think much of it.  I added more fiber and water to my diet and things would be ok again. Sometimes I also took Miralax for a few days to keep things moving along.

At the same time I seemed to be developing an incisional hernia from the three open surgeries I had so I kept thinking my difficulties were related to that.

I continued to be “ok” until earlier this year. I started having intermittent pain in my lower sigmoid area that I thought might be diverticulitis -related. It would start in the middle of the night and was so painful it would wake me up. I rarely ever run a fever however so I still wasn’t sure what it was.  After a few days, I wasn’t feeling better so I called my surgeon who immediately ordered a CT scan and blood test.

Both were negative for diverticulitis. Whatever it was, it wasn’t that.

Four days later I ended up in the emergency room. I hadn’t been able to pass gas or go to the bathroom for more than 24 hours and I was in tremendous pain. I felt like I had an obstruction of some kind.

This time the CT scan revealed what appeared to be a narrowing at the stapled anastomosis site suggesting the possibility of a stricture.  My hernia surgery was put on hold and I was scheduled for a colonoscopy and endoscopic balloon dilation at the hospital under sedation two weeks later.

The endoscopist was able to open the stricture a little bit using a series of inflatable balloons but still couldn’t get the scope through.  Because my body size is small and the stricture was very low, my surgeon was able to open it further using manual digital dilation to dislodge the web of scar tissue that was growing at the site and causing the stricture. In simple terms, he was able to reach the stricture with his finger and literally scrape the scar tissue off.

I felt much better for the first week. Two weeks later I was scheduled for a flexible sigmoidoscopy without sedation at my surgeon’s office to check out the site.  Sure enough, it had narrowed once again and he could not get the scope through.  Another digital dilation…this time I was awake.  Ouch. Big ouch.

After several weeks and another flexible sigmoidoscopy, much to my disappointment, the site had narrowed and restrictured.  So another trip to the hospital was scheduled for the following week and another attempt at a sigmoidoscopy and further digital dilation…this time under sedation.

My surgeon reassured me that with several more manual dilations he was confident that he would be able to stop the webbing and I would not need another surgery to fix this. He said he was able to open the stricture further than it had been before and he was able to get the scope through.

And now I wait for my next sigmoidoscopy in a couple weeks to see what’s what…I trust my surgeon with my life and I know if he says he can fix this, he can.

But I am also keeping my fingers and toes crossed too. Just in case…

What is your experience with a stricture?

Anastomosis Stricture/Dilation

Christine Joyce

Christine Joyce