A Case Report of Rectovesical Fistula Developing After Laparoscopic low Anterior Resection

Abstract

The patient reported herein was a 68-year-old man with rectal cancer (Ra) (StageⅢa; cT3cN1cM0c) who presented with a type-2 tumor mass. He underwent low anterior resection (Lap-LAR) with D2 lymph node dissection. The Denonvilliers fascia was preserved. The rectum proximal to the tumor was so severely distended that two automatic suturing devices were required to excise resect the involved rectal segment. The patient started taking meals orally could resume oral intake on postoperative day 4, however, he developed pneumaturia on postoperative day 10. Abdominal CT revealed air bubbles in the seminal vesicles, suggestive of a rectovesical fistula. He was asked to abstain from oral intake and given total parenteral nutritional support and antibiotic therapy. Subsequently, the fistula began to close and the patient was discharged on postoperative day 32. Rectovesical fistula is a very rare complication after operation for rectal cancer. A search of the Japan Medical Abstracts Society and Pubmed to the best of our ability revealed only 14 case reports until date, including our case. It has been reported that this complication could occur from the 9^th to 60^th postoperative day (median 13.5 days) due to anastomotic leakage. Careful judgment of the need for surgery to treat this condition is recommended, as these fistulas frequently heal with conservative treatment alone.