Successful Treatment of a Large Pelvic Abscess Using Intraluminal VAC: A Case Report

Abstract

The most feared complication of the surgical treatment of rectal cancer is anastomotic leakage, which is related to high rates of mortality and morbidity. Here, we present a patient who could not be treated with surgical drainage but treated by intraluminal Vacuum Associated Closure (VAC). A 34-year-old male patient was treated for rectal cancer by low anterior resection, colorectal anastomosis, and diverting ileostomy following neoadjuvant CRT. The patient reported with a postoperative anastomotic disruption and a large pelvic abscess. Due to the continuation of foul-smell drainage inspite of perianal incision and drainage, intraluminal VAC was applied and the pelvic abscess and the foul-smell were successfully treated. The presence of an adequate anal sphincter tonus is a disadvantage in anastomotic leakage, since it prevents the emptying of the intestinal content and also precludes the drainage of the pelvic abscess. The endoluminal application of VAC, similar to the results of application of VAC in open wounds, has been demonstrated to decrease fibrin and necrotic tissue in the pelvic cavity and increase granulation tissue. VAC, which has long been used in the treatment of open wounds, is a promising method in the treatment of large pelvic abscesses due to anastomotic leakage following rectum resection.

Keywords: Anastomotic leakage; Rectal Cancer; Sphincter; Vacuum Associated Closure.

[Table/Fig-1]:

Colonoscopy view of large pelvic abscess covered with dense purulent material.

[Table/Fig-2]:

The foam rubber covered with silicon with small holes.

[Table/Fig-3]:

The aspiration part of Vacuum associated closure that connected to anal part of foam rubber and anal sphincter was thinned and the closure of anal canal is provided.

[Table/Fig-4]:

Second foam was also placed into the surgical drainage incision.

[Table/Fig-5]:

The development of a granulation tissue was noted at the pelvic sinus through colonoscopy evaluation. Proximal colonic outlet which intestinal contents come through (Yellow arrow). Granulation tissue which fill pelvic abscess cavity (Blue arrow).