IMPROVED BALLOON‐TIPPED TRANS‐ANAL ILEUS TUBE

Background:  For management of bowel obstruction due to colorectal cancer, endoscopic trans-anal decompression technique has been first reported by Lelcuk et al. in 1986 using balloon dilatation technique. Since then, various types of trans-anal decompression tubes have been clinically used for patients suffering from left side obstructing colorectal cancer as an emergent decompressing device. At present, two types of trans-anal ileus tube (trans-anal decompression tube) have been available for clinical use, but they have two main problems that are late colon perforations caused by the tip of the tube and tube obstruction by stool. Methods:  Analysis on three late colon perforations experienced with the use of conventional devices drew possible improvements to make a trans-anal ileus tube less harmful. To overcome the pitfalls inherent to conventional tubes, the author has developed an improved trans-anal ileus tube with a balloon installed at the very end of the tube (‘balloon-tipped type’) made of silicone, measuring 1200 or 1700 mm in total length and 22 Fr in outer diameter. It has been used for 12 cases with obstructing colorectal cancer etc. and its outcomes were compared with those obtained by the use of conventional trans-anal ileus tube. Results:  No late perforations have been encountered, but tube obstruction did occur in one of 12 cases. Conclusion:  The new trans-anal ileus tube with a balloon installed at the tip of ileus tube is considered to be safer and especially effective in preventing late colon perforation and tube obstruction.