Published online Apr 25, 2016. doi: 10.4253/wjge.v8.i8.374
Peer-review started: November 12, 2015
First decision: December 7, 2015
Revised: January 16, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: April 25, 2016
A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.
Core tip: This case report demonstrates the importance of endoscopic biopsy using a cutting mucosal incision as a diagnostic tool for a submucosal mass that develops next to the staple line after sigmoid colon resection with a double-stapled anastomosis. We feel that these findings will be of special interest to the readers.