Treatment of completely obstructed anastomosis after low rectal resection A trans-anal plus endoscopic trans-colostomy rendez-vous approach and a review of the literature.

Aim: Completely obstructed anastomosis (COA) after low rectal resection (LRR) represents a rare entity difficult to manage. We herein summarize the available evidence from literature on the treatment of this condition and we report our particular experience in the management of a completely obstructed colon-anal anastomosis (CAA) with a trans-anal plus endoscopic trans-colostomy rendez-vous approach.

Methods: The Pub-Med database was inquired from inception to October 2019 about the treatment of COA after LRR reported in English literature. Article selection was carried out according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria. Moreover, clinical, radiological and surgical data of our case presentation were retrieved.

Results: Ten articles involving twelve patients and concerning the management of COA were identified. All of them reported the treatment of completely obstructed colon-rectal anastomosis. As we didn't find any article reporting the treatment of completely obstructed CAA, we also described a case of its treatment. The patient was successfully treated at our institution using a rendez-vous approach with a simultaneous trans-colostomy endoscopy, associated to a trans-anal dilatation. This combined approach, thanks to trans-illumination and to the miniature passage of CO2 coming from above, permitted to identify the correct way to surgically establish a trans-anal lumen. The post-procedural course was uneventful.

Conclusions: The treatment of COA after LRR can be very demanding, particularly after CAA. Few data are reported in literature to define the best approach to treat these conditions. Our described rendez-vous technique can represent a valid choice, especially after CAA.

Key Words: Colorectal anastomosis, Endoscopic treatment, Low-rectal resection.