Necrotizing pelvic infection after rectal resection. A rare indication of endoscopic vacuum-assisted closure therapy. A case report
| Autor: | Katherine Vomackova, M. Stasek, Tomáš Řezáč, Pavel Zbořil, Jan Hanuliak, Linda Bebarova, Čestmír Neoral |
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| Rok vydání: | 2019 |
| Předmět: |
Leak
medicine.medical_specialty ASA score The American Society of Anesthesiologists score Rectum Anastomosis Article 03 medical and health sciences 0302 clinical medicine ICU Intensive Care Unit Case report medicine ECOG performance status The Eastern Cooperative Oncology Group performance status Necrotizing pelvic infection EVAC endoscopic vacuum-assisted closure Anastomotic leak in colorectal surgery Groin medicine.diagnostic_test business.industry Low anterior rectal resection Colorectal surgery CT computed tomography Endoscopy Surgery Endoscopic vacuum-assisted closure (EVAC) medicine.anatomical_structure 030220 oncology & carcinogenesis NPI necrotizing pelvic infection CRP C-reactive protein CR POSSUM Colorectal Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity 030211 gastroenterology & hepatology BMI Body Mass Index Complication business Pelvic Infection |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Necrotizing pelvic infection after rectal resection is a rare complication. • There are no clear recommendations for the treatment of choice. • Multimodality therapy requires intensive care, antibiotics and usually repeated surgeries. • Endoscopic vacuum-assisted closure therapy may decrease the disease burden in properly indicated cases. Introduction Anastomotic leak after colorectal surgery is a major problem associated with higher morbidity and mortality. In most cases of contained leaks, treatment recommendations are clear and effective. However, in rare cases like necrotizing pelvic infection, there is no clear treatment of choice, despite the mortality rate almost 21%. We present successful management with endoscopic vacuum-assisted closure therapy. The presentation of a case A 68-year-old female patient with BMI 26, hypothyroidism and high blood pressure was indicated to low anterior rectal resection because of high-risk neoplasia of lateral spreading tumor type of the upper rectum. Four days after the primary operation, sepsis (SOFA 12) with diffuse peritonitis and unconfirmed leak according to CT led to surgical revision with loop ileostomy. On postoperative days 6–10, swelling, inflammation and subsequent necrosis of the right groin and femoral region communicating with the leak cavity developed. The endoscopy confirmed a leak of 30% of the anastomotic circumference with the indication of debridement and endoscopic vacuum-assisted closure therapy. EVAC sessions with 3–4 day intervals healed the leak cavity. Secondary healing of the skin defects required 4 months. Conclusion Necrotizing pelvic infection after a leak of the colorectal anastomosis is a very rare complication with high morbidity and mortality. Endoscopic vacuum-assisted closure therapy should be implemented in the multimodal therapeutic strategy in case of major leaks, affecting up to 270° of the anastomotic circumference. |
| Databáze: | OpenAIRE |
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