Delayed Anastomosis Leakage 7 Months after Laparoscopic Anterior Resection for Rectal Cancer: A Case Report

• Published in: Nippon Daicho Komonbyo Gakkai Zasshi Vol. 67; no. 1; pp. 29 - 34
• Main Authors: Ito, Daisuke, Nakajima, Shintaro, Hanyu, Ken, Suwa, Katsuhito, Okamoto, Tomoyoshi, Yanaga, Katsuhiko
• Format: Journal Article
• Language: Japanese; English
• Published: The Japan Society of Coloproctology 2014
• ISSN: 0047-1801; 1882-9619
• DOI: 10.3862/jcoloproctology.67.29

A 64-year-old man underwent laparoscopic anterior resection with D2 lymph node dissection for rectal cancer. His postoperative course was uneventful, and he was discharged on day 11 after surgery. He developed intestinal obstruction twice within 5 months after surgery, which were treated successfully with conservative therapy. He was admitted seven months after the operation because of induration with tenderness and redness in the midline abdominal wound. Abdominal computed tomography showed an accumulation of fluid containing gas just beneath the midline wound. Small intestinal adhesion was suspected around the rectal anastomosis. He underwent emergency surgery, in which an abscess was found to originate from the anastomotic region in the pelvis, and the anastomosis site and small intestinal adhesions had formed a mass. He underwent vemoval of the adhesions, partial resection of the intestine and drainage, but peritonitis developed two days later. The cause of peritonitis was judged to be a leakage from the anastomosis created at the time of the first operation, which was treated by colostomy. His postoperative course after colostomy was uneventful. Retrospectively, delayed anastomotic leakage (DAL) seemed to be responsible for intraabdominal and subcutaneous abscesses.