Conservative management of rectal perforation after nerve sparing endoscopic extraperitoneal radical prostatectomy (nsEERPE) in a patient with a past history of polypectomy.
BACKGROUND
Rectal polypectomy causes thinning (or even perforation) of the rectal wall in addition to thermic injury at the polypectomy site.


METHODS
We present a rare case of spontaneous rectal perforation after uncomplicated nerve sparing endoscopic extraperitoneal radical prostatectomy in a patient with a previous history of rectal polypectomy at the perforation site. The patient could be treated conservatively. There was complete healing of the fistula without any effect on functional results. This Conservative therapy for such rectal perforations is indicated if the patient's general condition remains stable without any signs of infection.


CONCLUSIONS
Polypectomy is an important risk factor for rectal perforation during nsEERPE. Adequate time interval should be given to allow healing and avoid adding further thermal wall damage which may obscure healing leading to complications like fistula. Conservative therapy for small missed rectal perforations constitutes an attractive, feasible and non invasive treatment entity. Following this principle we have not faced this complication in following similar cases.
Khoder
W Y
WY
Urologische Klinik und Poliklinik, Klinikum Grosshadern, Marchinionistr. 15, 81377 Munich, Germany. wael.Khoder@med.uni-muenchen.de
Becker
A J
AJ
Schlenker
B
B
Tritschler
S
S
Bastian
P J
PJ
Stief
C G
CG
D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D012002:Rectal Diseases / Q000209:etiology / Q000628:therapy*