Abstract
Colonoscopy-associated rectal perforation is rare but serious. Although a colostomy or laparotomy is frequently required, primary repair may suffice in selected cases. A 70-year-old woman with prior laparoscopic low anterior resection underwent surveillance colonoscopy and EMR. During retroflexion, a 3 cm perforation was noted 10 cm from the anal verge, which was located 7 cm proximal to the previous anastomosis at 3 cm from the anal verge. Endoscopic clipping failed due to the size and location of the lesion. No intraperitoneal contamination was evident. A transanal endoscopic approach (TAMIS) was employed using an Alexis® wound protector and insufflation. The defect was closed using 3-0 Vicryl under direct intraluminal visualization. Laparoscopic inspection confirmed no leakage. A transanal drain was left in place.
The postoperative course was uneventful. Inflammatory marker levels remained stable, and the patient was discharged on postoperative day 9 without complications. Transanal endoscopic repair is a viable, minimally invasive alternative for iatrogenic rectal perforations without gross contamination, potentially avoiding colostomy and improving the postoperative quality of life.
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