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ENDOSCOPIC MANAGEMENT OF RECURRENT ANASTOMOTIC LEAK FOLLOWING CHEMOTHERAPY AFTER COLORECTAL SURGERY

David J Morrell, MD, Kevin J Mckenna, MD, Evangelos Messaris, MD, PhD, Eric M Pauli, MD. Penn State Health Milton S. Hershey Medical Center

Introduction: The standard therapy for free intraperitoneal anastomotic leaks consists of surgical revision, diversion, and drainage. We present a patient managed endoscopically utilizing the same surgical techniques of source control and drainage.

Methods: Patient is a 62-year-old male with an anastomotic leak following open completion colectomy with ileorectal anastomosis for stage IIIB transverse colon cancer after starting chemotherapy postoperatively. This was managed endoscopically with over-the-scope-clip (OTSC) closure of the anastomotic leak as well as endoscopic guided percutaneous drain placement.

Results: The leak was initially managed effectively following placement of an OTSC and an endoscopic guided percutaneous drain. After resuming chemotherapy postoperatively, the patient had a recurrent anastomotic leak which was again managed successfully with repeat OTSC placement. At 3.4 months follow-up from the initial endoscopic procedure and 2.5 months from repeat endoscopy, the anastomotic leak has been successfully managed without surgical intervention. The drain remains in place pending completion of chemotherapy.

Conclusions: Endoscopic therapy has the potential to manage anastomotic leaks utilizing the same surgical principles of source control and drainage. This patient was able to avoid the morbidity of repeat laparotomy with diverting ostomy as well as subsequent redo anastomosis. This was accomplished with minimal interruption to chemotherapy.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94118

Program Number: V135

Presentation Session: Flexible Endoscopy II

Presentation Type: Video

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