Introduction: Anastomotic leak is one of the most feared and potentially life-threatening complications of colorectal surgery, with leak rates ranging from 3% to 10%. Endoluminal vacuum-assisted wound closure (EVAC) therapy is well known for treating esophageal perforations. However, there are few reports of its use in treating colonic perforations.
Case Description/Methods: A 60 years old woman presented to the emergency department with a one-week history of severe rectal pain worsening with defecation after undergoing robotic-assisted surgery one month prior for colonic adenocarcinoma. Computed tomography (CT) scan of the abdomen revealed a pre-sacral ill-defined collection measuring up to 3.6 centimeters (cm) of fat-stranding extraluminal gas and fluid posterior to the rectal surgical suture line concerning for anastomotic leak. Endoscopic repair was attempted using X-tack, which was unsuccessful. An endoluminal vacuum suction system was built using a GranuFoam sponge of approximately 5 cm x 3 cm, sutured to an NG tube, and placed partially into the cavity under endoscopic guidance. The system was renewed approximately every 72 hours three times, with complete closure of the leak one month later on follow-up endoscopy.
Discussion: Our case illustrates that endoluminal wound VAC therapy may be a good therapeutic option in the appropriate setting. Further studies are needed.
Figure: Figure 1a: Endoluminal vacuum device put together using nasogastric tube and granufoam. Figure 1b: Endoluminal vacuum set up at the anastomotic leak site via colonoscopy. Figure 1c: Follow-up colposcopy demonstrating healing of the anastomotic leak site
Disclosures:
Syed Mustajab Ahmed indicated no relevant financial relationships.
Russell Parvin indicated no relevant financial relationships.
Praneet Wander indicated no relevant financial relationships.
Uday Shankar indicated no relevant financial relationships.
Priyanka Chugh indicated no relevant financial relationships.
Syed Mustajab Ahmed, MD1, Russell Parvin, MD1, Praneet Wander, MD1, Uday Shankar, MD2, Priyanka Chugh, MD2. B0306 - Endoluminal Vacuum-Assisted Wound Closure Therapy for Anastomotic Leak Following Robotic-Assisted Colorectal Cancer Surgery, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
