Abstract
An 81-year-old woman who underwent laparoscopic-assisted low anterior resection with instrumented anastomosis using the double stapling technique for rectal cancer 5 years ago was found to have an enlarged anastomotic mass on computed tomography. On colonoscopy, the anastomotic mass was observed as a 30-mm-sized subepithelial lesion, which was presumed to be the submucosa on endoscopic ultrasonography (EUS). EUS-guided fine-needle aspiration was performed; however, no cellular components were collected. Therefore, endoscopic submucosal dissection (ESD) was performed to remove the entire anastomotic mass. However, any lesion in the submucosa was not detected during ESD, and the lesion was suspected to be located deeper than the submucosa. Therefore, EUS was performed from the muscule layer just below the dissected submucosa, and the mass was detected outside the muscle layer in contact with the rectal wall. Upon endoscopic incision of the muscle layer, milky white mucus was excreted into the rectal lumen. Subsequently, the scope was advanced to an area outside the muscle layer where the mass was located, which was a closed lumen with mucus retention. Surface biopsy of the closed lumen revealed normal colonic mucosa. Therefore, the subepithelial lesion was diagnosed as an implantation cyst arising outside the rectal wall.
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Acknowledgements
The authors would like to thank Dr. Hirofumi Sekino, Department of Radiology and Nuclear Medicine, Fukushima Medical University, for his advice in evaluating MR images. Moreover, the authors would like to express their deep appreciation to all the endoscopy medical staff and ward staff at Fukushima Medical University Hospital for their assistance with the endoscopic procedures and care of this patient.
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Conception, E.K., T.H., and M.H. Methodology, E.K., T.H., and M.H. Formal analysis, E.K. and M.H. investigation, J.N., T.K., T.Y., and W.S. Resource, E.K. and M.H. Data curation, M.K. and Y.H. Writing—original draft preparation, E.K., T.H., and M.H. Writing—review and editing, J.N., T.K., T.Y., W.S., M.K. Y.H. and H.O. Project administration, T.H. and M.H. All authors have read and approved the final version of the manuscript.
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Kameoka, E., Hikichi, T., Hashimoto, M. et al. Rectal implantation cyst successfully diagnosed using endoscopic myotomy and endoscopic ultrasonography. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01968-1
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DOI: https://doi.org/10.1007/s12328-024-01968-1