EXPERIENCE WITH ENDOSCOPIC TREATMENT OF COLORECTAL ANASTOMOTIC DEHISCENCE: CASE REPORT AND LITERATURE REVIEW

Case Presentation A 71-year-old man underwent a rectosigmoidectomy for adenocarcinoma of the upper rectum with primary anastomosis 4 cm from the anal verge, protective ileostomy, and prophylactic cavity drainage. On the 5th postoperative day, he developed a semicircular anastomotic dehiscence without signs of peritonitis or sepsis. Conservative treatment was chosen with antibiotics and maintenance of the cavity drain, which was well-positioned and draining purulent fluid. Clinical improvement allowed discharge on the 14th postoperative day, with the cavity drain still in place. Two months later, a follow-up colonoscopy revealed a patent anastomosis with a 1-cm fistulous opening communicating with a 3-cm cavity, through which the tubulolaminar drain was visible. Extraluminal vacuum therapy with an 18Fr endosponge was applied, later replaced by a double-tube system. After two weeks and three exchanges, the fistulous opening and tract were obliterated. Two weeks later, the ileostomy was closed with good postoperative recovery and discharge on the 3rd day. The patient subsequently presented with regular bowel movements and good continence.

Discussion Anastomotic fistula is the main complication of colorectal surgeries, occurring in up to 15-20% of cases, and is associated with significant morbidity. In stable patients with extraperitoneal anastomoses, particularly those with a pre-existing diversion stoma, minimally invasive treatments aimed at preserving the anastomosis are highly desirable. Endoscopic therapies, including stents, fibrin glue, clips, double pigtail catheter drainage, and, more recently, vacuum therapy, are noteworthy. Vacuum therapy works by removing fluids, reducing edema and bacterial load, increasing blood flow, and stimulating granulation tissue. The average treatment duration ranges from 35 to 60 days, requiring multiple dressing changes, which can be made with sponges or a double-tube structure, with or without substance instillation. Early intervention is associated with better outcomes.

Conclusion Early consideration of endoscopic vacuum therapy can increase the resolution rates of colorectal fistulas with shorter treatment durations, reducing reoperation rates and permanent stomas. However, high costs, prolonged treatment times, and the availability of trained professionals remain limiting factors in the widespread use of this technique.

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

Publication History

Article published online:
25 April 2025