Intestinal Stricture
Intestinal stricture is the partial or total narrowing of the large intestine (or rarely the small intestine) that prevents the progression of content through it.
Intestinal stricture can occur due to 2 main causes:
1- Intestinal tumors: some intestinal tumors can grow to the point of causing obstruction of the organ. In these cases, surgery is usually performed to remove the affected part of the intestine. In very advanced cases, a self-expanding stent can be passed through colonoscopy for decompression. This stent can also be placed to improve the physical condition and preparation of the patient before a definitive surgery is performed.
2- Benign stricture: some inflammations of the intestine can, upon healing, lead to retraction of the organ wall and closure of the same. Diseases such as Ulcerative Colitis, Crohn’s Disease, radiation-induced Colitis, and some intestinal infections can lead to this process. There are also postoperative strictures that occur when there is an exaggerated healing of the remaining intestinal wall after surgery.
In cases of benign intestinal strictures, endoscopic dilation of the region with a hydrostatic type balloon is performed.
Strictureplasty
On some occasions, the narrowing (stricture) is so severe that even the dilation instruments cannot pass. In these cases and in some other situations, the procedure of strictureplasty is performed. This consists of making small cuts in the region of the stricture with the help of a stylet that is passed through the working channel of the endoscope. These small cuts help to open the narrowing, facilitating the passage of dilators and accelerating the treatment process. In some cases, after making the small cuts, some substances, such as corticosteroids, are injected into the region to prevent the narrowing from closing again easily.
In cases where there is no improvement with dilations, surgical treatment of the problem is performed through the procedure called partial colectomy.
Complications
Colon dilation is generally performed effectively and without problems. Some complications that may occur are:
- A small amount of bleeding almost always occurs when dilation is performed. If this bleeding is excessive, it may require more aggressive treatment.
- Another complication is perforation (a hole in the wall of the organ). If this happens, an operation may be necessary to repair the problem.
- Rarely, a small perforation can lead to infection, which can remain localized or even spread to neighboring organs.
Residência em Endoscopia Digestiva no Hospital das Clínicas da USP (HCFMUSP)
Residência em Gastroenterologia no Hospital Universitário da UFSC
Presidente da SOBED / SC na gestão 2018-2020
Médico da clínica Endogastro em Florianópolis e ProGastro em Joinville