Fluoroscopy-Guided Colonoscopic Transanastomotic Drainage of a Delayed Presacral Collection After Rectal Cancer Surgery: A Case Report.

Anastomotic leakage after rectal resection may present months after surgery as a contained presacral collection. When an established defect communicates with the rectal lumen, endoscopic transanastomotic drainage can use that tract without creating a new transmural access route. We report a 54-year-old man who presented six months after anterior rectal resection with fever, pelvic pain, tenesmus, and purulent rectal discharge. Pelvic magnetic resonance imaging showed a multiloculated 6 × 5 × 2 cm presacral collection with a fistulous tract to the posterior colorectal anastomosis. Radial endoscopic ultrasonography measured a longest cavity dimension of 87.1 mm, and colonoscopy identified a draining posterior anastomotic defect. After intravenous antibiotic therapy was initiated, the defect was cannulated under colonoscopic and fluoroscopic guidance, the cavity was lavaged, and a 7-Fr × 7-cm double-pigtail plastic stent was deployed for internal drainage. Symptoms and inflammatory markers normalized within one week. At two months, a residual 40-mm cavity remained, and a second identical stent was placed alongside the first. At three months, the patient remained asymptomatic, but both stents were still in situ, and definitive cavity closure had not yet been documented. This case demonstrates the technical feasibility of transanastomotic drainage and short-term clinical control in a selected patient without peritoneal signs; it does not establish durable healing or generalizable efficacy.