Pelvic MRI in the diagnosis of necrosis of a pulled-through colon segment after abdomino-anal resection of the rectum for cancer

This study presents a case of necrosis of the pulled-through colon after abdomino-anal resection of the rectum, which was diagnosed by magnetic resonance imaging. A 47-year-old man underwent laparoscopically assisted abdomino-anal resection of the rectum with reconstruction of a coloplasty pouch and transverse colostomy in the course of combination treatment for locally advanced rectal cancer. The postoperative period was complicated by the development of an inflammatory response syndrome. On postoperative day 3, contrast-enhanced magnetic resonance imaging revealed swelling of the 15-cm segment of pulled-through colon up to the coloanal anastomosis with sharply attenuated contrast enhancement, whereas rectoscopy showed no changes. On postoperative day 6, a magnetic resonance imaging scan revealed a defect in the anterior wall of the coloplasty pouch with a parietal aerocele, and rectoscopy showed signs of necrosis of the bowel wall. On postoperative day 10, the magnetic resonance imaging scan presented no changes. Because of increasing signs of inflammation, relaparotomy with anastomosis disconnection and resection of the necrotized bowel segment were performed. Ischemia of the pulled-through colon after rectal surgery is a rare but serious complication. Our clinical case report demonstrates the potential of contrast-enhanced magnetic resonance imaging as a non-invasive method in case follow-up in patients with a complicated postoperative period for early diagnosis of ischemia and bowel wall defects, which helps to make the appropriate patient management plan.