A Case of Colon Perforation Caused by a Transanal Tube after Low Anterior Resection

A 53-year-old man was evaluated for a positive fecal occult blood test. Since colonoscopy showed a carcinoid tumor in the rectum below the peritoneal reflection, he was referred to our hospital and under-went laparoscopic low anterior resection. A drain adjacent to the colorectal anastomosis and a transanal tube were placed. A gastrografin enema on postoperative day (POD) 5 showed no anastomotic leakage and compression of the posterior wall of the sigmoid colon by the transanal tube. This tube was removed on the same day. Fecal liquid discharge drained from the abdominal drain on POD 6. Because fistulogra-phy showed a communication with the sigmoid colon through the fistula of the transanal tube, colon perforation caused by this tube was diagnosed. The patient had massive melena on POD 9. Computed tomography demonstrated active bleeding from the anterior surface of the sacrum, and emergency surgery was performed. Diverting ileostomy was also performed on POD 63, because conservative therapy for colon perforation was not successful. He then recovered and was discharged 81 days after the initial surgery. Colon perforation caused by a transanal tube is a rare postoperative complication. This case is reported along with a review of the literature.