Transostomy endoscopic vacuum therapy of anastomotic dehiscence after a low anterior resection

Endoscopic vacuum therapy (EVT) is an established strategy for the management of GI perforations and postsurgical leaks. Typically, EVT is used in the upper GI tract and requires hospital admission. The aim of this manuscript is to describe a case in which EVT was used to manage a patient with a subacute lower GI anastomotic dehiscence in the outpatient setting.

A 73-year-old woman with stage IIIB rectal adenocarcinoma underwent a lower anterior resection with colorectal anastomosis and creation of a transverse colostomy. The patient later endured adverse events, including dehiscence of the anastomosis and development of a presacral abscess. To manage this patient as an outpatient, we made the decision to perform EVT by placing a sponge into the abscess cavity by using the ostomy as a conduit.

The patient was managed as an outpatient for the duration of treatment. The patient underwent 18 flexible sigmoidoscopy procedures with sponge exchange over 60 days. After treatment, the abscess resolved, and the patient did not require additional intervention.

This case demonstrates the effective use of EVT for the management of colorectal dehiscence in the outpatient setting by taking advantage of the existence of a transverse colostomy.