Rectal perforation from a perianal drain repaired with transanal minimally invasive surgery
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Rectal perforation from a perianal drain repaired with transanal minimally invasive surgery L. Pérez Santiago1 · D. Moro Valdezate1 · M. Lapeña Rodríguez1 · V. Pla Martí1 · J. Martín Arévalo1 · A. Espí Macías1 Received: 26 April 2020 / Accepted: 22 June 2020 © Springer Nature Switzerland AG 2020
After anorectal abscess drainage, a Pezzer drain (Fig. 1) was left in place ultimately causing rectal perforation. The lesion was assessed with three-dimensional endoanal ultrasound (Fig. 2) and successfully repaired with a running suture of absorbable barbed monofilament via transanal minimally invasive surgery without faecal diversion. The transanal access through the GelPoint P ath® (Applied Medical, USA) was safe and feasible and should therefore be considered for repairing penetrating injuries of the lower third of the rectum (Fig. 3) [1].
Fig. 1 Pezzer drain coming out through the anus, above the previous internal fistulous orifice. The blue seton is placed in the fistula tract
* L. Pérez Santiago [email protected] 1
Coloproctology Surgery Unit, General Surgery Department, University Clinical Hospital of Valencia, University of Valencia, Avda. Blasco Ibáñez Nº17, 46010 Valencia, Spain
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Fig. 2 Hydrogen peroxide-enhanced three-dimensional endoanal ultrasound. A transsphincteric fistula with a suprasphincteric extension. The internal fistulous orifice (IFO) 1 (primary) was at 33.8 mm
from the anal margin and the IFO 2 (iatrogenic) was in rectum at 55.3 mm from the anal margin
Fig. 3 Repair of rectal lesion. a Iatrogenic internal fistulous orifice (IFO) (between white arrows) and primary IFO with blue loose seton.
b, c Primary running suture of the lesion with absorbable barbed monofilament suture. d Rectal lesion repaired (between black arrows)
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Compliance with Ethical Standards
Reference
Conflict of interest The authors declare that they have no conflict of interest.
1. Behrenbruch C, Read D, Hayes I (2019) Use of the GelPoint Path access channel for rectal trauma. ANZ J Surg 89(12):E589–E590. https://doi.org/10.1111/ans.14997
Ethical approval This article does not contain any studies without human participants or animals performed by any of the authors. Informed consent For this type of study, formal consent is not required.
Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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