We present a case of a 40-year old male that presented in our emergency department with clinical signs of ileus. He has been operated (subtotal colectomy with formation of ileosigmoid anastomosis) due to obstructive Crohn's disease in 2015. Five days before actual clinical presentation he was on an elective colonoscopy that revealed fibrotic stenosis of the anastomosis, not passable with the scope, lumen width 4-5 mm. 

During the next few days he started feeling bloated with progressive abdominal pain, nausea, absence of stool and at the end vomiting. He came to our emergency room- basic lab test were normal with just slight elevation of inflammatory parameters, but X-ray and then CT scan revealed ileus on the level of the ileocolic anastomosis. He was seen by a surgeon, started with conservative treatment (NG tube, antibiotics), but during the next 12 hours clinical condition and x-ray did not improve. After that we have been consulted by a surgeon and made a quick decision to perform endoscopy that revealed complete obstruction of the ileocolic anastomosis. Due to high surgical risk (multiple adhesions, risk of anastomotic leak and formation of high output stoma), we offered the patient possibility of urgent endoscopic intervention/decompression.

We changed the scope to therapeutic one, pushed the LAMS hot axios 20x10mm through the working channel and with the help of guide wire and fluoroscopy placed the LAMS in classical manner over the anastomosis. Immediately after the LAMS placement, liquid stool was evacuated. During the next day patient had multiple stool and gas evacuation and complete clinical and radiological regression of ileus so he was discharged 48 hours after the procedure. 

LAMS was extracted with forceps 3 weeks after the placement, anastomosis was widely opened, and the patient remained completely asymptomatic during the follow up.

This case is to show that with slightly "extraordinary" approach we can save the patient from radical surgery.