Published in:
01-11-2020 | Ultrasound | The Last Image
Rectal perforation from a perianal drain repaired with transanal minimally invasive surgery
Published in: Techniques in Coloproctology | Issue 11/2020
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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 Path® (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
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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