Year 2026 / Volume 118 / Number 3
Letter
Continuous endoscopic manual suturing for colorectal anastomotic fistula closure

184-185

DOI: 10.17235/reed.2024.10904/2024

José Manuel Palma García, Raúl Honrubia López, Beatriz Tormo Lanseros, Carmen Rodríguez Haro, María Hernández, Carmen Jiménez Ceinos, Carmen Comas Redondo,

Abstract
A 54-year-old male underwent a low anterior resection in 2015 for rectal adenocarcinoma. He presented to the emergency department with a two-week history of fever, perianal pain, an erythematous, warm, and actively draining mass. Physical examination revealed a perianal abscess in the left posterior gluteal region, with a palpable internal fistulous orifice 3 cm from the anal margin. Abdominal and pelvic CT and MRI demonstrated a discontinuity in the distal sigmoid colon pre-anastomotic, communicating with a perirectal abscess and an extrasphincteric fistulous tract towards the left ischioanal fat. Despite initial antibiotic therapy with amoxicillin/clavulanic and poor clinical response, colonoscopy revealed a 10 mm, erythematous, and friable fistulous orifice at the anastomosis. Histopathology did not reveal any adenomatous or dysplastic tissue. Vacuum-assisted closure was attempted but was unsuccessful due to technical difficulties and the small size of the cavity. Given the characteristics of the fistula, we proceeded with continuous manual suturing after argon application, achieving complete closure of the fistulous opening. However, after two weeks, there was a sluggish evolution. A follow-up colonoscopy showed persistence of the fistulous orifice with suture material, although radiologically there was a clear decrease in the abscess. Finally, after one month of hospitalization with a stable fistula but no definitive resolution, a planned surgical intervention was decided.
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References
1. Fujinaga Y, Mitoro A, Yoshiji H. Endoscopic hand suturing for nonhealing gastrocutaneous fistula after gastrostomy tube removal. Dig Endosc. 2024 Feb;36(2):230-231.
2. Hayashi Y, Nagumo H, Fujimoto A, et al. An effective endoscopic hand-suturing method for fistula closure after endoscopic transgastric drainage for walled-off necrosis. VideoGIE. 2024 Mar 9;9(6):278-280.
3. Kantsevoy SV, Bitner M, Mitrakov AA, et al. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc. 2014 Mar;79(3):503-7.
Citation tools
Palma García J, Honrubia López R, Tormo Lanseros B, Rodríguez Haro C, Hernández M, Jiménez Ceinos C, et all. Continuous endoscopic manual suturing for colorectal anastomotic fistula closure. 10904/2024


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Publication history

Received: 28/10/2024

Accepted: 09/11/2024

Online First: 09/01/2025

Published: 06/03/2026

Article Online First time: 73 days

Article editing time: 494 days


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