Non-surgical treatment of anastomotic leakage after rectal resection - a case report

Background. Colorectal anastomosis leakage remains a significant concern after colorectal surgery. Non-surgical dealing with anastomotic leak involves making complex decisions based on patient stability and radiographic findings. Case presentation. A 59-year-old male patient diagnosed with stage I rectal cancer, which prompted rectal resection with the formation of a transverso-rectal anastomosis. On 4th postoperative day transanal hemorrhage and wound infection indicated the possible leakage of anastomosis, but no clear leakage was identified radiologically. The patient responded positively to antibiotic therapy, experiencing an improvement in his overall condition and was discharged on 14th postoperative day. However, 5 days later, the patient's health deteriorated, marked by symptoms such as high fever, nausea, and hypotension. Computer tomography revealed a substantial 12x3 cm pelvic abscess close to anastomosis and signs of ileus. Additional endoscopy unveiled a 5 mm width defect in the colorectal anastomosis. To solve this complication, a 7 Fr pig tail drain was strategically placed, and the patient was initiated on parenteral feeding to ensure proper nutrition. A follow-up colonoscopy in 1 week identified a confined cavity, prompting the insertion of two additional pig tail drains. With stable vitals and no signs of peritoneal involvement, the patient was eventually discharged. In following 3 months patient underwent endoscopic removement of pig tail drains, followed by full recovery. Conclusions. This comprehensive case report underscores the critical need for physicians to remain vigilant in recognizing potential risk of colorectal anastomosis. In selected cases endoscopic techniques are suitable to manage anastomotic leakage.