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A 78 year old male with previous history of rectal cancer at 6 cm from the anal verge that had received neoadjuvant therapy because by clinical staging was a cT3N1 tumor. Surgical treatment was performed with a low anterior resection plus a diverting stoma that was closed after a correct follow up.
This patient suffered from a complicated diverticulitis that required a Hartmann's procedure; at the postoperative period he developed pelvic collections, episodes of subocclusion and nephroureteral dilation that required multiple readmissions.
A water-soluble enema and a CT Scan showed a chronic failure with a collection at the rectal stump.
The surgery was accomplished by combined transabdominal and transanal approach, a GelPOINT device was placed at the zone of the colostomy to hand-assist the procedure.
There are several adhesions of the small bowel to the pelvis due to the chronic inflammatory process, the transabdominal team takes down these adhesions while the transanal surgeons dissect the rectal stump. There is a lot of fibrosis and the tissues tend to bleed.
The maneuvers progress and the dissection of the teams reaches each other and help to identify the unclear surgical planes respecting the pelvic vessels and ureters.
Once the rectal resection is finished a manual coloanal anastomosis and a protective ileostomy were performed and bilateral pigtails were placed.
After surgery a water soluble enema showed a correct anastomosis.