Kono-S anastomosis for recurrent ileocolic anastomotic stricture in Crohn’s disease: a case report

Background and importance: Crohn’s disease frequently requires surgical intervention due to strictures and bowel obstruction, yet postoperative recurrence remains common. Anastomotic stenosis represents a significant cause of re-intervention. Presentation of case: We present a 32-year-old man with Crohn’s disease who developed a symptomatic ileocolic anastomotic stricture 8 months after ileocecal resection. Endoscopic evaluation and computed tomography confirmed critical stenosis. Two endoscopic balloon dilations provided only temporary relief. Redo resection with Kono-S anastomosis was performed, with resection of approximately 20 cm of bowel. Clinical discussion: The Kono-S anastomosis is a hand-sewn antimesenteric technique designed to preserve luminal caliber and reduce recurrence by limiting mesenteric influence. It may be a useful option in redo surgery following a failed conventional stapled anastomosis, particularly in complex recurrent cases. Conclusion: This case sheds light on the technical feasibility of the Kono-S anastomosis in managing recurrent ileocolic anastomotic stricture in Crohn’s disease. However, as this is a single-case report, further evidence is needed to confirm its long-term safety and efficacy.