Ileal J-Pouch interposition as a salvage technique for failed coloanal anastomosis: a case report

Surgical management of low rectal cancer can be challenging, particularly when postoperative complications such as anastomotic leakage and ischemia arise. This case report highlights the use of an ileal J-pouch interposition as an innovative solution in a patient with compromised colonic length and perfusion.

We present the case of a 50-year-old female patient with diabetes who underwent an intersphincteric resection, coloanal anastomosis, and appendicostomy, followed by an Antegrade Colonic Enema (ACE) for T2N0 rectal adenocarcinoma in November 2020. Postoperatively, she developed anastomotic leakage and a rectovaginal fistula due to ischemia, requiring a second surgery. Intraoperatively, the left and transverse colon were ischemic, leaving only the right colon viable, perfused by the ileocolic artery. Due to insufficient length for coloanal anastomosis, an ileal J-pouch was created and anastomosed to the anal canal, with the right colon connected to the pouch. The patient has achieved favorable long-term oncologic and functional outcomes, maintaining good bowel control with loperamide and ACE.

This case underscores the complexities of surgical management in low rectal cancer and the potential use of ileal J-pouch interposition as an effective solution for complications arising from primary surgical efforts. Further long-term studies are warranted to evaluate the sustainability of this approach in similar patient cohorts.