A Creative Solution for a Difficult Case: Endoluminal Negative Pressure Therapy for the Management of Colorectal Anastomotic Leak

Rectal anastomotic leaks can lead to significant morbidity with potentially devastating consequences for patients' intestinal continuity and quality of life, which are challenging to manage. With a growing interest in endoluminal negative pressure therapy (eNPT), which was first described for use in esophageal anastomotic leaks, the technique has been more recently adapted to colorectal anastomoses. We discuss a case of a patient with rectal cancer, who underwent total neoadjuvant therapy, ultralow anterior resection, and diverting loop ileostomy. The patient suffered an anastomotic leak and presacral abscess. Attempts at conventional management to control pelvic sepsis were unsuccessful. We present the novel creation of an eNPT device (a manufactured one is not readily available in Canada), which allowed control of sepsis, substantial reduction in abscess size, and safe discharge home for the patient. This experience suggests this is a safe and feasible treatment alternative for this challenging problem.