ENDOSCOPIC TREATMENT OF COLORECTAL ANASTOMOSIS FISTULA

Case Presentation A 38-year-old obese female patient developed a colorectal anastomosis fistula on the 7th postoperative day following laparoscopic retossigmoidectomy for complicated acute diverticulitis (Hinchey III). The patient was treated with endoscopic vacuum-assisted closure through colonoscopy, resulting in complete closure of the fistula within two weeks. We will demonstrate, through video, how this procedure was performed.

Discussion Endoscopic vacuum therapy has become a well-established therapeutic option in the treatment of gastrointestinal fistulas, and it has shown promising results for colorectal anastomotic fistulas. It is a less invasive method for correcting anastomotic fistulas, effective in stable patients without generalized peritonitis. This technique promotes healing by stimulating granulation tissue formation, reducing edema and bacterial proliferation, and enhancing local vascularization. The treatment involves inserting an endoscopic sponge at the site of the lesion, connecting it to a vacuum system, typically for 7 to 14 days, with success rates of up to 92% in studies.

Conclusion Endoscopic therapy is an excellent option for clinically stable patients with colorectal anastomotic fistulas, presenting high success rates and low complication rates. While it is not yet widely available in the Brazilian healthcare system, we believe that, once fully established, it will lead to a reduction in morbidity, avoiding further surgical interventions, and consequently reducing hospital costs.

 

MissingLinkText

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

Publication History

Article published online:
25 April 2025