The Gatekeeper™ for fecal incontinence: Another trial and error

Abstract

Introduction: The Gatekeeper™ is the most recent bulking agent used in the treatment of fecal incontinence with no reported complications. This case reports side effects similar to other bulking agents, namely migration of the prosthesis and perianal abscess.

Presentation of case: A 52 year old gentleman presented with a history of fecal soiling. He underwent uncomplicated surgery in 2012 for 6 Gatekeeper™ implantations with only temporary improvements. In 2013, endorectal ultrasound revealed prosthesis migration. In 2014, he presented with a perianal abscess which contained one of the prosthesis.

Discussion: The Gatekeeper™, made of the inert Hyexpan, typically implanted in the intersphincteric region, has been used for the treatment of fecal incontinence since its discontinuation in the treatment of gastroesophageal reflux disease.(5) The Gatekeeper™ was implemented on a small number of subjects for which the typical side effects of bulking agents were not seen.

Conclusion: Larger studies need to be conducted to investigate the advantages or perhaps disadvantages of the Gatekeeper™ over other bulking agents.

Keywords: Bulking agents; Fecal incontinence; Gatekeeper.

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1

Endorectal ultrasound showing the migrating gatekeepers.

Fig. 2

Migrated Gatekeeper near the prostate level.

Fig. 3

Gatekeeper prosthesis obtained from incision site of perianal abscess.