Ileal pouch anal anastomosis leak after restorative proctocolectomy without protective stoma successfully treated with endoscopic vacuum therapy

• Authors: Maciej Borejsza-Wysocki , Adam Bobkiewicz , Tomasz Kościński , Tomasz Banasiewicz , Łukasz Krokowicz

Abstracts

EN

Aim An ileal pouch anal anastomosis (IPAA) leak is one of the most severe complication after restorative proctocoletomy (RPC). We present a rare case of a successful management of IPAA leak after RPC without defunctionig stoma with the utility of endoscopic vacuum therapy. Methods A 57-year-old male with a ileal pouch anal anastomosis leak after RPC due to ulcerative colitis with presacral abscess was qualified for endoscopic vacuum therapy (EVT). The abscess of the left buttock was drained and secured with suction drain (redon drain). Due to the lack of defunctioning stoma, a system for contain and divert fecal matter was placed within afferent limb of the J-pouch and EVT was placed directly within IPAA dehiscence. EVT was changed every third day. Results The patient underwent a total of five EVT sessions. Improvement of patient’s general condition characterized with lack of pelvic pain, fever and reduction of inflammatory markers was achieved. Locally, anastomosis dehiscence was healed with prominent reduction in the defect’s dimension, contraction and revascularization. Based on imaging studies no chronic presacral sinus or any other perianal disturbances were revealed at the time of five months follow up. Conclusions EVT is a promising method for management of IPAA leak. Although, it remains extremely difficult, EVT may serve as a method of choice in early pouch-related septic complications after RPC performed without defunctioning stoma

Keywords

EN

anastomotic leakage; Endoscopic vacuum therapy; negative pressure wound therapy; restorative proctocolectomy

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2020
• Volume: 92(4)
• Pages: 58-62

Dates

published

2019-10-16

Contributors

author

Maciej Borejsza-Wysocki

author

Adam Bobkiewicz

author

Tomasz Kościński

author

Tomasz Banasiewicz

author

Łukasz Krokowicz

Identifiers

DOI

10.5604/01.3001.0013.5357