STERCORAL PERFORATION: MINIMALLY INVASIVE COLORECTAL SURGERY IN THE EMERGENT SETTING

Objectives: This video demonstrates a minimally invasive resection of a rectosigmoid perforation secondary to stercoral ulcer. A 70-year-old female with a history of coronary artery disease, rheumatoid arthritis and COPD presented with 5 days of abdominal pain and constipation. On physical exam she was hemodynamically stable with soft, but distended abdomen with bilateral lower quadrant tenderness and voluntary guarding. CT showed pneumoperitoneum and a complex air fluid collection in the pelvis consistent with a rectosigmoid perforation. The patient was taken to the operating room for robotic assisted abdominal exploration.

Methods: The abdomen was entered with an optical port in the left upper quadrant, followed by insertion of 2 additional ports. The abdomen was explored laparoscopically and adhesiolysis was performed. 3 additional ports were placed, and the robot was docked. A full-thickness bowel defect was found in the upper rectum, consistent with stercoral perforation. The colon was mobilized, and mesentery was taken down. An area of healthy colon was chosen as the proximal transection point. Indocyanin green was administered, and the portion of the bowel chosen for the colostomy was noted to have excellent blood supply. A robotic staple cartridge was used to transect the bowel. The robot was undocked, and the proximal colon was brought through the skin in the left lower quadrant to form a colostomy.

Results: The patient had an uneventful post-operative course and recovered well.

Conclusion: This case demonstrates that colorectal emergencies can be treated safely using minimally invasive techniques.