Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor

Abstract

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.

Penetration into free abdominal cavity during transanal endoscopic rectal resection for adenoma

“…Al-Najami et al [12] сообщают, что в их исследовании 5 из 12 пациентов (42%) с проникновением в свободную брюшную полость потребовалась конверсия в открытую хирургию (операция Гартмана, низкая передняя резекция прямой кишки, чрезбрюшинное ушивание дефекта кишки), остальным пациентам (58%) дефект кишки удалось ушить трансанально. В литературе даже описано одно наблюдение развития сепсиса при пневмоперитонеуме после трансанальной эндоскопической резекции прямой кишки [13]. Тем не менее, при проникновении в свободную брюшную полость не всегда требуется лапаротомия, возможно местное ушивание.…”

Approach to the patient with pneumoretroperitoneum

“…While it can give a dramatic radiological appearance, most cases can be successfully managed conservatively 1 . Aetiologies reported in literature include colonoscopic perforation, retroperitoneal infection by gas‐forming organisms, and instrumentation such as Endoscopic Retrograde Cholangiopancreatography (ERCP), trans‐psoas lumbar spinal surgery, transanal and retroperitoneoscopic procedures 2–6 …”