Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports

Figure 1 Schematic drawing of the transanal opening of the intersphincteric space procedures. A: Intersphincteric space infection in anastomotic leakage; B: The transanal opening of the intersphincteric space technique opens the internal orifice of the fistula and adequately drains the intersphincteric space using a transanal approach.

Figure 2 Case 1. A: Computed tomography scan revealed contrast medium spill outside the rectum; B: Colonoscopy revealed a pin-hole fistula in the left-posterior rectal wall, indicating the formation of an anastomotic leak; C: After transanal opening of the intersphincteric space, re-examination through colonoscopy displayed intact anastomosis with a local scar without obvious mucosal depression or defect. Circle: Area of contrast medium extravasation; arrows: Opening site of the anastomotic fistula.

Figure 3 Case 2. A: Abdominal computed tomography scan revealed a discontinuous anastomosis and the formation of an anastomotic leak; B: Subsequently after transanal opening of the intersphincteric space, an abdominal computed tomography scan showed that the anastomosis was continuous with no obvious gap; C: The colonoscopy confirmed that the anastomotic defect was healed. Arrows: Healing site of the anastomotic fistula opening.

Figure 4 Case 3. A: Pelvic magnetic resonance imaging revealed anastomotic leak after low anterior resection; B: Subsequently, after transanal opening of the intersphincteric space, contrast-enhanced magnetic resonance imaging demonstrated an intact anastomosis; C: Colonoscopy revealed an intact and complete anastomosis. Yellow arrows: Area of anastomotic fistula opening; white arrows: Healing site of the anastomotic fistula opening.