Abstract
A 42-year-old male complained of bloody stool. A colonoscopy revealed a type 2 tumor, 30 mm in diameter, 15 mm from the dentate line of the lower rectum. The biopsy showed a well differentiated adenocarcinoma. A partial intersphincteric resection with a transverse coloplasty and a transverse colostomy was performed. On pathology, a well differentiated adenocarcinoma invading into the propria muscle layer with no lymph node metastasis was diagnosed. He was discharged 21 days after surgery. A gastrographin enema performed a month after the operation showed intrapelvic leakage at a transverse coloplasty site. Although conservative therapies were administered, a gastrographin enema performed 11 months after surgery continued to show an intrapelvic fistula. Thus, surgical repair using a gluteus maximus musculocutaneous flap was performed 15 months after the first surgery. Gastrographin enema showed no intrapelvic fistula and the transverse colostomy was closed. Four years and four months after the closure of the colostomy, the patient recovered well, without any evidence of recurrence ; fecal continence was well preserved. Surgical repair using a gluteus maximus musculocutaneous flap was effective in our case.
