Complete rectal anastomotic occlusion that spontaneously recanalized, allowing for unusual endoscopic treatment with a LAMS: a case report.

Introduction: Complete anastomotic occlusion following rectal surgery is a rare and challenging complication. While surgical revision remains the standard treatment, it is associated with significant morbidity. Recently, novel endoscopic techniques have emerged as minimally invasive alternatives. Case Presentation: We report the case of a 64-year-old patient who developed complete rectal anastomotic occlusion after low anterior resection and declined further surgery. Five months later, spontaneous recanalization was observed, allowing for successful endoscopic treatment using a lumen-apposing metal stent (LAMS). The stent was later removed, and ileostomy reversal was completed successfully. Conclusion: Watchful surveillance for spontaneous recanalization may offer a safe opportunity for endoscopic intervention in selected high-risk, diverted patients with complete rectal anastomotic occlusion. LAMS may serve as an effective alternative to fully covered self-expandable metal stents in cases of severe strictures.