'Not so rare' Wilson disease

摘要

Background: Treatment of the presacral cavity that forms after contained anastomotic leakage of a low pelvic anastomosis is challenging and often results in a permanent stoma. Endosponge? therapy is a minimally invasive method of treating the presacral cavity which potentially avoids a permanent stoma. We report our initial experience of using Endosponge? therapy. Methods: All patients who underwent Endosponge? treatment for low pelvic anastomotic leakage in our hospital over a 45-month period were identified and data collected from clinical, operative and endoscopic notes. Results: Eight patients (seven males, one female) underwent Endosponge? therapy for extraperitoneal pelvic anastomotic leak during the study period; all had had defunctioning ileostomies placed at their original surgery. Six out of eight patients had complete closure or a reduction in the size of the abscess cavity. Five patients have had their ileostomies reversed with good or reasonable bowel function after a median follow-up of 41 months and four of these patients had Endosponge? therapy instituted within 6 weeks of initial surgery. One patient had Endosponge? therapy abandoned and conversion to a permanent end colostomy after accidental intraperitoneal placement of the sponge. Conclusions: Early use of Endosponge? therapy appears to offer a minimally invasive and effective way of closing the presacral cavity after a pelvic anastomotic leak, reducing the risk of permanent stoma and resulting in acceptable bowel function. Endosponge?-specific complications can occur.