Seminal Vesicle-Rectal Fistula Secondary to Anastomotic Leakage After Low Anterior Resection for Rectal Cancer: A Case Report and Brief Literature Review

Abstract

We report a case of a patient with seminal vesicle-rectal fistula, an extremely rare complication of low anterior resection of the rectum. A 53-year-old man with rectal adenocarcinoma underwent low anterior resection in our hospital. The patient experienced diarrhea, pneumaturia, and low-grade fever on postoperative day 13. A computed tomography scan showed emphysema in the right seminal vesicle. We concluded that anastomotic leakage induced a seminal vesicle-rectal fistula. The patient underwent conservative therapy with total parenteral nutrition and oral intake of metronidazole. Diarrhea and pneumaturia rapidly improved after metronidazole administration and the patient was successfully cured without invasive therapy such as colostomy or surgical drainage. A seminal vesicle-rectal fistula is a rare complication of low anterior resection, and therapeutic strategies for this condition remain elusive. Our report provides valuable information on the successful conservative treatment of a secondary seminal vesicle-rectal fistula that developed after low anterior resection of the rectum in a patient.

Seminal vesicle‐rectal fistula: A review of an unusual complication following low anterior resection for rectal cancer

“…This was used to identify 11 of 13 cases, and would also be the best modality to identify evidence of anastomotic leak. Contrast studies, such as water‐soluble contrast enema, fistulography, vasogram and irrigoscopy, were also used in some cases.…”

“…On review of the literature, we found that it is widely accepted that fever and pneumaturia are the most common presenting symptoms. Fever is described in 10 of 13 cases, and pneumaturia in 10 of 13 cases . Fever is of course a very nonspecific symptom, whereas pneumaturia should be considered highly suggestive of fistulation between urinary tract and a newly‐formed low rectal anastomosis in any setting.…”

“…SV‐R fistula is an extremely rare occurrence following low anterior resection for rectal cancer. Only 12 cases have ever been described in the literature . As such, there is no clear consensus to explain why they occur or which patients are at risk.…”

“…Laparoscopic techniques could provide the surgeon with an improved view using angled laparoscopes and greater access low in a male pelvis. However, laparoscopic access does not appear to be protective, as SV‐R fistulae are equally described in the literature in open and laparoscopic cases …”

“…Complications following low rectal anastomosis include leak, abscess, fistulae and anastomotic stenosis. Seminal vesicle‐rectal (SV‐R) fistulation is a complication that is not commonly reported, and as such, there is no algorithm for the management of these patients . In the present review, risk factors that lead to the development of SV‐R fistula are highlighted, and management options for this uncommon and challenging morbidity are proposed.…”