TREATMENT OF COLORECTAL ANASTOMOSIS FISTULA WITH VACUUM THERAPY GUIDED BY COLONOSCOPY

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Case Presentation A 77-year-old female patient with chronic kidney disease, hypothyroidism, and hearing impairment underwent a rectosigmoidectomy, colonic lowering with colorectal anastomosis, and protective ileostomy in 2021 due to diverticular disease. The surgical procedure was completed without complications. On the fourth postoperative day, the patient underwent a CT scan, revealing a small presacral collection without contrast extravasation through the colorectal anastomosis. With antibiotic therapy, she had a good postoperative recovery. Three months later, a postoperative colonoscopy identified an anastomotic fistula 7 cm from the anal margin, with purulent secretion. An attempt at expectant treatment was unsuccessful. Surgical attempts including debridement, suturing, and clipping of the orifice also failed. In March 2023, the patient underwent curettage of the tract and vacuum dressing placement via colonoscopy. Successive follow-up at 7 and 14 days showed effective granulation of the fistulous tract. A subsequent endoscopic evaluation at 21 days revealed increased granulation tissue with erosion in part of the tract leading to the intestinal lumen, resulting in a septum of the sinus tract with lowered colon. After three months, a septotomy was performed, and no fistula was documented on colonoscopy or MRI. The patient later underwent ileostomy closure without any leakage at the colorectal anastomosis. Discussion Colorectal fistulas affect up to 14% of patients undergoing surgical treatment and can be fatal in 7% of cases. However, many cases are asymptomatic or mildly symptomatic. Factors contributing to a lower risk of fistula formation in anastomoses include adequate blood supply, tension-free anastomosis, and the patient’s clinical condition. Endoscopic therapy with negative pressure is successful in most cases, with healing rates of around 90% and few adverse events. Literature suggests that the average treatment duration may range from 18 to 47 days, with about 4 to 7 endoscopic procedures. Conclusion In the reported case, the patient presented with a refractory benign colorectal anastomosis fistula, resistant to several treatments. Vacuum therapy guided by colonoscopy is not a widely used treatment method but offers high success rates and minimal harm to the patient. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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