Laparoscopic Abdomino-perineal Resection Followed by Early Postoperative Acute Small Bowel Obstruction- A Case Report with Review of Literature

Abdominoperineal Resection (APR) is the long established therapeutic surgical procedure for cancers of the lower rectum. With the advent of minimal access surgery, APR too has come under its ambit. The large pelvic peritoneal defect and raw area left behind, after dissection are unique to APRs. This report describes the case of a 75-year-old male patient diagnosed with low rectal cancer, who underwent a laparoscopic APR and developed an early post-operative adhesive acute small bowel obstruction. Having failed a trial of conservative management, the same was successfully managed by a re-look laparoscopy. The risk of post-operative adhesions decreases significantly with laparoscopy. APR (whether open or laparoscopic), is a unique operation that causes the formation of a large pelvic raw area, which is very prone to attracting small bowel adhesion/s. The advent of various anti-adhesion barriers (liquid and films) has helped in decreasing the incidence of adhesions. However, in spite of the availability of a wide array of options, there is no consensus among surgeons as to the most optimum agent. Ideally, a tension free closure of the pelvic peritoneal defect formed during APR should be attempted. Failing this, covering of the wide pelvic raw area by a dual mesh or an anti-adhesion barrier agent (fluid or film) or omentopexy have been reported as adhesion preventing manoeuvres. Interceed® promises to be a useful long term adhesion preventing barrier option.