Severe complications from anastomotic leakage after total mesorectal excision with the protective loop ileostomy in three patients

Qizhi Liu; Minjun Zhou; Zhuo Chen; Junyi Chen; Dehua Zhou; Cheng Xin; Xiaohuang Tu

doi:10.1016/j.ijscr.2022.107066

Severe complications from anastomotic leakage after total mesorectal excision with the protective loop ileostomy in three patients

Int J Surg Case Rep. 2022 May:94:107066. doi: 10.1016/j.ijscr.2022.107066. Epub 2022 Apr 11.

Authors

Qizhi Liu¹, Minjun Zhou¹, Zhuo Chen¹, Junyi Chen¹, Dehua Zhou¹, Cheng Xin², Xiaohuang Tu³

Affiliations

¹ Department of Gastrointestinal Surgery, Shanghai Fourth People's Hospital, Tongji University, Shanghai 200434, China.
² Department of Colorectal Surgery of Changhai Hospital, Naval Medical University, Shanghai 200433, China.
³ Department of Gastrointestinal Surgery, Shanghai Fourth People's Hospital, Tongji University, Shanghai 200434, China. Electronic address: tuxiaohuang@126.com.

Abstract

Introduction and importance: A protective loop ileostomy is recommended in ultra-low rectal cancer to reduce the complications associated with anastomotic leakage (AL), but there are few studies on the complications after AL. The purpose of this study was to outline our experience in the successful treatment of severe abdominal infection after AL in rectal cancer patients with the protective loop ileostomy.

Case presentation: In this report, we describe three cases of AL after standard total mesorectal excision with the protective loop ileostomy. Severe abdominal infection occurred postoperatively. The patients were successfully treated by surgical reintervention and had an uneventful recovery. No recurrence was observed after 2 years.

Clinical discussion: We consider that pelvic floor reconstruction and extending the extubation time should be performed in patients with a high risk of AL. Moreover, when severe abdominal infection and early infectious shock occur after AL, immediate reoperation should be performed to minimize the complication.

Conclusion: Protective loop ileostomy can't decrease the re-operation rate for patients with AL. We should take preventive measures during and after the operation, as well as early detection and early treatment.

Keywords: Abdominal infection; Anastomotic leakage; Protective loop ileostomy.