External Small Intestinal Fistula as a Rare Complication of Total Pelvic Infralevator Evisceration

Abstract

A clinical case of a patient with external incomplete non-formed small intestinal fistula involving previously formed ureteroejunoanastomosis in infiltrate and presence of purulent cavity in small pelvis communicating with external medium in perineum is presented. This complication occurred after a planned surgery in the volume of total infralevatory evisceration of the pelvis due to local advanced rectal cancer. The patient underwent this complication for a long time and performed independent dressings. The following examinations (Rg-fistulography, multispiral computed tomography of abdominal organs with intravenous bolus contrast) revealed a purulent cavity communicating with the adductor loop of the small intestine. During the planned surgical intervention, it was intraoperatively revealed that the previously formed interintestinal anastomosis and ureteroejunoanastmoses were involved in the infiltrative process, which complicated this situation. Resection of the latter with reconstruction of anastomoses was performed. The main task in this situation was adequate drainage of the purulent cavity and the previously formed anastomosis. The postoperative period in this patient underwent no peculiarities, the drainage was removed on the 10th day. Further, the patient underwent a follow-up examination and further examination. Examination of data for intestinal fistula relapse did not reveal. A control multispiral computed tomography with contrast was performed - there are no data for relapse of the purulent cavity of the cavity, previously formed intergestinal anastomosis and conduit function adequately. In this clinical case, the patient's medical history, the clinical example of the occurrence of this complication and its cause, further treatment of the patient aimed at eliminating the small intestinal fistula, as well as an overview of the literature data on this problem are described in detail.