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Dr. Robert D. Fusco, Medical Director    
Dilating a Colonic Stricture with a Balloon

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Narrow Colon Stricture
 
This 78 year old widow underwent abdominal surgery to remove a colon cancer in the past and recently has been having a problem with "pencil-thin" stools. She complained that her bowel movements are difficult to pass and are quite narrower than normal. She and her family doctor were obviously concerned about another cancer in her colon. At colonoscopy, Dr. Fusco was surprised to find that the surgical seam (anastomosis) where her colon was reconnected had become quite narrow. This was caused by scar tissue, not cancer. The scope could not fit throught this narrow spot. In the photo you can see that instead of being several inches across, it was almost like a pinhole in apprearance. No wonder she was having problems moving her bowels. Also, this narrow spot prevented her from having a full colonoscopy exam to be sure that new polyps had not formed further within her colon.

 
  Balloon in Stricture
  In this photo, you can see the balloon dilator catheter which has been passed through the center channel of the colonoscope. Under direct vision, the deflated cigar-shaped balloon is carefully placed to straddle the stricture. The balloon is then inflated with water. As it inflates and becomes wider, the narrow ring is stretched and becomes more open. The balloon dilators come in a variety of sizes. The larger the size the larger the diameter of the balloon. Dividing the size (like 45F) by 3 gives you the approximate width of the balloon. So a 54F balloon is about 18 millimeters wide.  
  Stricture After Dilation
  After the balloon dilator was deflated and removed, the stricture is seen to be more open. The patient was advised to begin a high fiber diet to help keep the stricture from reclosing.  
  Normal Colon Above
  After dilation was completed, the thinner pediatric colonscope was easily passed beyond the stricture and the entire remaining colon was examined. She was relived that no additional polyps or cancer were present within the colon. She is to return every three years to be rechecked.  

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