Asian Journal of Case Reports in Surgery

Introduction: Anastomotic leakage after colectomy is a potentially life-threatening complication. We report the first case treated by the nonoperative management using the transanal long tube for major leakage after colectomy.

Presentation of Case: We report a 50-year-old woman who underwent a laparotomy for left hemicolectomy with end-to-end anastomosis to treat a cancer of the descending colon, as well as total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy to address endometrial cancer. On postoperative day (POD) 3, ascites containing feces was detected in her abdominal drainage tube, consistent with a major anastomotic leak. The general conservative treatment such as fasting and intravenous antibiotics did not improve her condition. On POD6, a long transanal drainage tube was inserted beyond the anastomosis and placed at the splenic flexure. Adequate drainage was achieved, and ascites drainage from the abdominal tube was soon reduced. The patient’s symptoms, fever, and laboratory inflammatory parameters improved and the fistula closed on POD 51. At the 2-year follow-up she was alive and well without recurrence.

Discussion and Conclusion: Managing anastomotic leakage after colectomy using transanal long drainage tube might be effective in clinically stable patients with localized peritonitis. Due to the inherent limitation of a single case report, the further studies are warranted for development of the nonoperative approach.