A case of a late intractable fistula due to anastomotic breakdown after surgery for rectal cancer for which endoscopic cyanoacrylate infusion was effective

Abstract

The patient was a 59-year-old man who underwent preoperative chemoradiotherapy for lower rectal cancer in February 2003, followed by low anterior resection in March 2003 (pStageIIIa). Anastomotic breakdown occurred after the surgery and colostomy was made. The drain region became a fecal fistula, but the fistula spontaneously closed. The colostomy was closed in May 2004 after confirming the absence of anastomotic breakdown by imaging. However, the fecal fistula recurred in the left lower abdomen in April 2005. Percutaneous infusion of fibrinogen failed to close the fistula. Then a contrast imaging catheter for ERCP was inserted by about 5 cm endoscopically via the anus and cyanoacrylate was infused. The fistula was closed and no recurrence has occurred as of 3 years and 10 months after the infusion. This case shows that a fistula due to anastomotic breakdown following digestive tract surgery, particularly after radiotherapy, may become intractable and difficult to treat. Endoscopic cyanoacrylate infusion was effective in our case.