J Gynecol Oncol.  2011 Jun;22(2):131-134. 10.3802/jgo.2011.22.2.131.

Sonographic diagnosis and Endo-SPONGE assisted vacuum therapy of anastomotic leakage following posterior pelvic exenteration for ovarian cancer without using a protective stoma

• Einenkel J
• Holler B
• Hoffmeister A

• KMID: 2288578
• DOI: http://doi.org/10.3802/jgo.2011.22.2.131

Abstract

Anastomotic leakage is a very significant complication after posterior pelvic exenteration and a major cause of postoperative morbidity and mortality. We present a patient who underwent an optimal debulking surgery for an advanced stage ovarian cancer (FIGO IIIC). On postoperative day 12, transvaginal ultrasound revealed an anastomotic dehiscence following an unsuspicious computer tomography scan the day before. The patient was successfully managed by transanal vacuum therapy without re-laparotomy within a period of 4 weeks after diagnosis. We conclude that high-resolution transvaginal ultrasound is a crucial method in the management of complications after surgery and even allow diagnosing leakages of colorectal anastomosis. In selected cases characterized by a small leak size and a local peritonitis confined to the pelvis a transanal vacuum therapy may avoid both surgical re-intervention and creating a secondary diverting stoma.

Keyword

Posterior pelvic exenteration; Anastomotic leakage; Ovarian cancer; Transvaginal ultrasound

MeSH Terms

Anastomotic Leak
Humans
Ovarian Neoplasms
Pelvic Exenteration
Pelvis
Peritonitis
Vacuum

Figure

• 

  Fig. 1 (A) Transvaginal ultrasound of the rectum revealed a distinct anastomotic leak in the posterior wall (arrow). (B) Schematic drawing of the transanal Endo-SPONGE® insertion into an abscess cavity following examination and rinsing of the cavity using a flexible endoscope. Inset: The Endo-SPONGE® is an open-pored, cylindrical polyurethane sponge connected to a drainage tube which is linked to a vacuum system to exert constant suction (authorized by Aesculap AG, Germany). (C-H) Endoscopic images demonstrating the treatment course: initial finding of the anastomotic disruption with two openings of 15 and 3 mm (C), first-time insertion of the sponge fitted to the size of the pelvic abscess cavity measuring 30×30 mm (D), progressive obliteration of the cavity and narrowing of the opening by granulation tissue on days 9 (E), 13 (F) and 20 (G), and final finding of the anastomotic site almost completely covered by mucosa on day 27 (H) after initial diagnosis of the leakage.

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