Ann Surg Treat Res.  2015 Apr;88(4):236-239. 10.4174/astr.2015.88.4.236.

Transanal gauze packing to manage massive presacral bleeding secondary to prescral abscess caused by rectal anastomotic leakage: a novel approach

• Yoo BE
• Lee DW
• Lee SW
• Kwak JM
• Kim J
• Kim SH

• KMID: 2167027
• DOI: http://doi.org/10.4174/astr.2015.88.4.236

Abstract

Anastomotic leakage following rectal resection is a serious and fearful complication, and may cause presacral abscess and/or peritonitis. To our knowledge, massive hematochezia secondary to presacral abscess caused by anastomotic leakage has not yet been reported in the literature. We observed this rare and life-threatening complication in three patients who were successfully treated with a simple but effective transanal gauze packing technique.

Keyword

Rectal resection; Anastomotic leak; Presacral abscess; Massive hematohezia; Gauze packing

MeSH Terms

Abscess*
Anastomotic Leak*
Gastrointestinal Hemorrhage
Hemorrhage*
Humans
Peritonitis

Figure

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  Fig. 1 Presacral abscess (arrow) secondary to anastomotic leakage is detected on abdominopelvic CT.

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  Fig. 2 One roll of Vaseline-coated gauze.

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  Fig. 3 The illustration shows how the rolled Vaseline gauze is packed through the anus.

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  Fig. 4 Sigmoidoscopy shows the anastomosis was completely healed without stricture, sinus, or fistula formation.

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  Fig. 5 A fistula between the terminal ileum and sigmoid colon (arrow) is seen on abdominopelvic CT.

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  Fig. 6 A small sinus (arrow) is detected on sigmoidoscopy (A) and gastrografin enema (B).

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