RARE COMPLICATION OF ENDOSCOPIC VACUUM THERAPY FOR ANASTOMOTIC LEAK IN COLORECTAL SURGERY – A DEEP MIGRATION

Aims In colorectal oncologic surgery the number of sphincter preservation procedures has increased but also has the number of anastomotic leaks (AL). For selected patients Endoscopic vacuum therapy (EVT) is a valid alternative. The more often reported complications of EVT are bleeding, pelvic abscess, luminal stenosis, ileal or urethral fistula. We describe an unusual and potentially severe complication of EVT.

Methods A 29 year old male with diagnosis of low rectal adenocarcinoma underwent neoadjuvant chemoradiotherapy (CRT). Eight weeks after, the restaging exams showed absence of complete clinical response. He was proposed for a low anterior resection. At 10^th postoperative day the diagnosis of AL was made and EVT was started. After the first 2 sessions of EVT, the AL improved and he was discharged under EVT ambulatory treatment.

Results On the 3^rd EVT session the drain bottle was empty and vacuum system was non-functioning. The manual attempt to remove the sponge led to the detachment of the drainage tube. In endoscopy the sponge had obviously migrated upwards through the leak cavity. The patient underwent emergency laparotomy to remove the sponge from between the pelvic loops of the small bowel. After 3 days he was discharged and he restarted EVT a week latter, with complete AL closure after 4 additional sessions.

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Conclusions Despite some potential complications, like intraperitoneal migration, EVT is a highly effective technique, with huge positive impact on patient’s quality of life, by making the intestinal tract reconstruction possible.

Publication History

Article published online:
14 April 2022