PRESERVATION OF COLORECTAL ANASTOMOSIS AFTER DEHISCENCE USING VACUUM THERAPY – CASE REPORT

Case Presentation The case involves J.C.L., a 58-year-old male patient with hypertension and diabetes. He was diagnosed with high rectal adenocarcinoma, stage T3bN1 based on MRI, with no distant metastases. Surgical treatment was indicated, and a robotic-assisted low anterior resection with partial mesorectal excision, protective ileostomy, and cavity drainage was performed. Postoperatively, the patient experienced a slow recovery, presenting with prolonged metabolic ileus during hospitalization. On the 5th postoperative day, the drain showed fecaloid discharge. Abdominal CT revealed signs of colorectal anastomotic dehiscence on the posterior wall with a 20mL adjacent collection. Considering the patient's stable clinical condition and the diverted intestinal transit, conservative treatment was chosen. This included antibiotic therapy and the installation of transanal vacuum therapy. Rectoscopy revealed an 80% dehiscence in the colorectal anastomosis. A continuous suction tube at 125mmHg was placed inside the recess, with the system exit via the anal route. After five days, there was significant improvement and tissue granulation, prompting a replacement and continuation of the vacuum system for an additional seven days. At the end of this period, control endoscopy showed resolution of the anastomotic disruption. Three weeks after vacuum therapy removal, the anastomosis was intact and patent, with no signs of stenosis. Six months after the initial surgery, intestinal continuity was restored with the closure of the protective ileostomy.

Discussion Postoperative complications in colorectal surgeries are a significant topic of concern. Among them, anastomotic fistulas and dehiscences are the most feared. Vacuum-assisted therapy is a relatively new approach for treating colorectal anastomotic dehiscences. It involves the use of a negative pressure system to promote better healing, secretion drainage, vascularization, and stimulation of healthy tissue growth at the site.

Conclusion This case report demonstrates that, in selected cases, vacuum therapy can yield satisfactory outcomes, allowing the preservation of colorectal anastomosis and reducing the need for surgical re-intervention in oncology patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025