Overuse of Proximal Fecal Diversion in Colorectal Surgery

Clinical using of innovative biodegradable stent with extension sleeve in Ta_tme for low rectal cancer with high risk of anastomotic leakage

The objective of this paper is to observe and evaluate the safety and feasibility of using a degradable colorectal endoluminal stent with extension sleeve(DCESES) in patients at high risk of anastomotic leakage following low anterior resection (LAR) for rectal cancer using the transanal total mesorectal excision (Ta_tme) technique. Six patients with low rectal cancer undergoing Ta_tme surgery and identified as high risk for anastomotic leakage were selected. During surgery, the tumor was mobilized transanally and excised outside the anus. A suitable biodegradable stent was chosen and connected to a sterile extension sleeve. The stent was fixed with absorbable sutures 5 cm proximal to the intestinal cut end. Anastomosis was then completed at the anus, and the extension sleeve was pulled through the anus to externalize, diverting fecal matter and preventing contact with the anastomotic site. None of the six patients underwent a prophylactic ileostomy. All six patients successfully underwent Ta_tme surgery with the implantation of the biodegradable colorectal endoluminal stent with an extension sleeve. Within 3-4 weeks postoperatively, the stent disintegrated into fragments and was expelled through the anus along with the plastic sleeve. All patients experienced no significant perianal discomfort, anastomotic leakage, anastomotic stricture, or other complications during the perioperative period. Fecal diversion using a biodegradable stent with an extension sleeve in high-risk patients for anastomotic leakage following Ta_tme is safe and feasible. This approach effectively prevents complications such as anastomotic leakage and stricture during Ta_tme, avoiding the need for prophylactic ileostomy and its associated complications, thereby reducing patient suffering, saving medical resources, lowering medical costs, and improving patient quality of life.

Infected Haematoma Fistulating Through Adjacent Colorectal Anastomosis Mimicking an Anastomotic Leak

Anastomotic leakage is a well-understood major complication of colorectal surgery and carries significant implications for patient morbidity and mortality. However, an infected collection fistulating through an otherwise healthy colorectal anastomosis can mimic an anastomotic leak and warrants different management to a primary anastomotic leak. Such a presentation is undocumented in the current literature. A 42-year-old man underwent an elective perineal rectosigmoidectomy (Altemeier's procedure) for full-thickness rectal prolapse. Early postoperative computed tomography (CT) imaging demonstrated a large haematoma in the rectovesical pouch. He represented 13 days later with fevers and lower abdominal pain. CT revealed that the known haematoma had evolved into an infected collection. At this stage, there was an intact anastomosis on imaging with no evidence of fistula formation or an anastomotic leak. There was a four-day delay between diagnosis and drainage of the abscess. By then, the collection had developed gas and a subsequent CT fistulogram confirmed a fistula had formed between the colorectal anastomosis and abscess, resembling an anastomotic leak. The patient was treated successfully with a diverting ileostomy and percutaneous drainage. We present a unique case of an infected haematoma fistulating rapidly through an otherwise healthy colorectal anastomosis, mimicking an anastomotic leak 17 days after an Altemeier procedure.

Late anastomotic perforation of the ileum 3 years after intestinal resection

Late perforation of the ileum is a rare and potentially life-threatening complication following intestinal resection. We present a unique case of a woman in her 60s with a history of appendiceal carcinoid tumour, who underwent a right hemicolectomy. Positron emission tomography and surveillance CTs showed normal surgical changes and no recurrent malignancy. Three years postoperatively, she presented with severe abdominal pain. CT revealed a perforation along the ileal wall of the ileocolonic anastomosis. She underwent emergent resection and repeat ileocolonic anastomosis. We conclude that the patient had subclinical ischaemia of the anastomosis, which eventually progressed to perforation 3 years later. We discuss a literature review on late small intestinal anastomotic perforations and their associated risk factors. Our case and literature review emphasise the importance of considering delayed anastomotic leak in postoperative patients with a history of intestinal cancer, inflammatory bowel disease, Roux-en-Y enteroenterostomy or side-to-side anastomosis.

Elderly Rectal Cancer: An Updated Review

PURPOSE OF REVIEW

Treatment of rectal cancer patients of advanced age should be modulated by life expectancy and tolerance. Due to the rapid advance of this field, we aim to conduct an updated review of this topic.

RECENT FINDINGS

The field of elderly rectal cancer has advanced a lot. This review covers all the treatment aspects of elderly rectal cancer, including the prognostic factor, surgery, radiotherapy, chemotherapy, and palliative treatment. We also provide the future aspect of the management of elderly rectal cancer. The advancement of prognostic factor research, surgery, radiotherapy, chemotherapy, and palliative treatment has made the care of elderly rectal cancer patients better. The future of these fields should focus on the definition of the elderly and the application of particle therapy.