Fistula Resolution and Preservation of the Lower Colorectal Anastomosis with VAC System

Abstract

Colorectal anastomotic dehiscence is a serious post-surgical complication that significantly increases morbidity, mortality, length of hospital stay, and medical care costs. Its frequency ranges from 4 to 26%. Risk factors include advanced age, malignancy, prolonged surgical time, preoperative radiation therapy, and perioperative blood loss or transfusion requirements. Clinical manifestations can be varied, including the presence of abdominal pain or distension, leukocytosis, presence of pus, meteorism, fecal leakage through drains or the surgical incision, and in the most severe cases, peritonitis and sepsis with multi-organ failure. Early diagnosis is essential and timely treatment will depend on its clinical repercussions. Rarely, they do not require active therapeutic intervention but may delay ostomy closure. Most patients require antibiotic treatment, percutaneous or endoscopic drainage, and, in cases of peritonitis and systemic inflammatory response syndrome, surgical intervention. Endoluminal vacuum therapy is a minimally invasive endoscopic technique that allows drainage and obliteration of the peri-anastomotic spaces with a success rate that varies from 75 to 97%, depending on early diagnosis. We describe the case of a 76-year-old female patient with a history of obesity and adenocarcinoma of the rectum who underwent a low colorectal anastomosis and creation of a protective ileostomy, which evolved with a symptomatic anastomotic leak that was successfully treated with endoscopic vacuum therapy.