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Transanal gauze packing to manage massive presacral bleeding secondary to prescral abscess caused by rectal anastomotic leakage: a novel approach.

Yoo BE, Lee DW, Lee SW, Kwak JM, Kim J, Kim SH - Ann Surg Treat Res (2015)

Bottom Line: Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis.To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature.We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.

View Article: PubMed Central - PubMed

Affiliation: Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis. To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature. We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.

No MeSH data available.


Related in: MedlinePlus

Presacral abscess (arrow) secondary to anastomotic leakage is detected on abdominopelvic CT.
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Figure 1: Presacral abscess (arrow) secondary to anastomotic leakage is detected on abdominopelvic CT.

Mentions: A 60-year-old man with rectal cancer located 10 cm from the anal verge (AV) underwent robotic low anterior resection (LAR) with double-stapled end-to-end anastomosis. On postoperative day (POD) 3, the patient developed fever (39.0℃), vague low abdominal pain, and the color of the pelvic drain changed. Abdominopelvic CT confirmed anastomotic leakage with perianastomotic abscess confined to the pelvic cavity (Fig. 1). CT-guided transgluteal percutaneous drainage was performed but fever and abdominal pain was not improved. On the following day, diverting ileostomy with peritoneal lavage was performed by a relaparoscopic approach and an additional pelvic drain was placed. Twelve days after the reoperation, the transgluteal drainage catheter was removed because the presacral abscess cavity shrunk on abdominopelvic CT. On POD 21, the patient suddenly developed massive hematochezia (900 mL). Sigmoidoscopy failed to identify the bleeding site because of a large amount of bleeding and hematoma.


Transanal gauze packing to manage massive presacral bleeding secondary to prescral abscess caused by rectal anastomotic leakage: a novel approach.

Yoo BE, Lee DW, Lee SW, Kwak JM, Kim J, Kim SH - Ann Surg Treat Res (2015)

Presacral abscess (arrow) secondary to anastomotic leakage is detected on abdominopelvic CT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384289&req=5

Figure 1: Presacral abscess (arrow) secondary to anastomotic leakage is detected on abdominopelvic CT.
Mentions: A 60-year-old man with rectal cancer located 10 cm from the anal verge (AV) underwent robotic low anterior resection (LAR) with double-stapled end-to-end anastomosis. On postoperative day (POD) 3, the patient developed fever (39.0℃), vague low abdominal pain, and the color of the pelvic drain changed. Abdominopelvic CT confirmed anastomotic leakage with perianastomotic abscess confined to the pelvic cavity (Fig. 1). CT-guided transgluteal percutaneous drainage was performed but fever and abdominal pain was not improved. On the following day, diverting ileostomy with peritoneal lavage was performed by a relaparoscopic approach and an additional pelvic drain was placed. Twelve days after the reoperation, the transgluteal drainage catheter was removed because the presacral abscess cavity shrunk on abdominopelvic CT. On POD 21, the patient suddenly developed massive hematochezia (900 mL). Sigmoidoscopy failed to identify the bleeding site because of a large amount of bleeding and hematoma.

Bottom Line: Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis.To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature.We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.

View Article: PubMed Central - PubMed

Affiliation: Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis. To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature. We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.

No MeSH data available.


Related in: MedlinePlus