Bowel perforation following transanal irrigation in low anterior resection syndrome

Low anterior resection syndrome (LARS) is a frequent problem encountered by patients after rectal cancer surgery, significantly affecting quality of life. Though transanal irrigation (TAI) is an effective management option for LARS symptoms, the treatment can still cause rare but severe complications, such as bowel perforation. We present a very rare case of a 78-year-old patient who developed a bowel perforation after 13 years of regular TAI. Gluteal pain, swelling, and purulent discharge were observed as presenting symptoms. Imaging and clinical examination revealed a perforated blind-ended bowel segment and a communicating abscess in the buttock. Urgent abscess drainage was performed, followed by an intersphincteric abdominoperineal excision and vacuum-assisted wound management (negative-pressure wound therapy). This case highlights the importance of long-term vigilance in patients using TAI, regardless of duration of use. Ongoing patient education, correct technique, and regular follow-up are essential to minimize risks and enable early detection of complications. Teaching patients how to care for themselves, using the right methods, and checking regularly are needed to control risks and see issues right away.