ABSTRACT
CASE MANAGEMENT A CT scan with oral, rectal, and intravenous contrast demonstrates a contained anastomotic leak. The patient is managed with pecutaneous drainage and intravenous antibiotics.
INTRODUCTION Surgical research over the past three decades has vastly enhanced our technical abilities and knowledge with respect to creating colorectal anastomoses. The Miles operation, considered state of the art for many years after its description in 1908, has been supplanted by sphincter-saving operations which are now considered the gold standard for the majority of patients with rectal cancer. The era of anal sphincter salvage was ushered in with the commercialization of mechanical staplers that permitted colorectal surgeons to resect cancers even in the distal rectum and maintain intestinal continuity.(1)
In 1979, Heald articulated the concept of total mesorectal excision for rectal cancer resection which was subsequently validated and popularized adding a new dimension to our understanding of curative rectal cancer surgery.(2) In addition, appreciation of the distal mural spread of rectal cancer allowed for closer distal margins without compromising oncologic adequacy. Concomitantly, chemoradiation was demonstrated to be an effective adjuvant therapy and became part of the armamentarium routinely used to treat patients with rectal cancer. With the ushering in of the era of low, stapled colorectal anastomoses, and sphincter preservation, experience was gained diagnosing and treating patients in whom complications of these operations arise.
