Rectovesical Fistula as a Rare Complication after Laparoscopic Low Anterior Resection: a Report of Two Cases

Abstract

Rectovesical fistula is a rare complication following low anterior resection (LAR) for rectal cancer. We report two cases of rectovesical fistulas that developed after laparoscopic low anterior resection (Lap-LAR). The first patient was a 67-year-old man who underwent Lap-LAR with D3 lymph node dissection for RaRb rectal cancer. The Denonvilliers’ fascia was simultaneously resected. The patient’s immediate postoperative course was uneventful; however, he developed a fever, pneumaturia and dysuria without symptoms of peritonitis on postoperative day (POD) 9. Abdominal CT demonstrated air bubbles in the right seminal vesicle and urinary bladder, and rectovesical fistula was diagnosed. The second patient was an 82-year-old man who underwent Lap-LAR for Ra rectal cancer. The operation was performed in a similar fashion to that described in the first case. The patient developed a mild fever, pneumaturia and testicular pain without symptoms of peritonitis on POD 12 and rectovesical fistula was diagnosed. Both patients were conservatively treated with antibiotics and immediately recovered, although some reports have described difficulties in conservatively treating this entity. As a complication after LAR, rectovesical fistulas are associated with anastomotic leakage. The development of rectovesical fistulas is likely promoted by localized abscess formation and vulnerability of the exposed seminal vesicle due to resection of the Denonvilliers’ fascia. To the best of our knowledge, this is the first report in Japan on rectovesical fistulas occurring after Lap-LAR.