Pelvic sepsis from chronic anastomotic leak complicating rectal cancer surgery

Chronic pelvic sepsis following low anterior resection of rectum for cancer remains a clinical challenge. Although under reported, it is still a major problem associated with impaired quality of life. Chronic pelvic sepsis should be avoided as much as possible as it is more difficult to manage than the acute sepsis. A better understanding of the pathophysiology and natural history may enable its prevention and better management. Secondary prevention of chronic pelvic sepsis is by early detection and the active treatment of the acute anastomotic leak (AL). A critical appraisal of original studies on chronic pelvic sepsis complicating anterior resection of rectum for cancer and the management was performed. Drainage of the sepsis and diversion is the key. High success rates can be achieved with surgical salvage of pelvic sepsis in dedicated referral centres. The results of the operative intervention depend upon the technique employed and have mostly favourable outcome in well selected and motivated patients. Redo- anastomosis is favourable when there is no more sepsis, the lesions are stabilized or a large presacral cavity. The delayed coloanal pull-through anastomosis (Turnbull- Cutait) is preferred in impaired pelvic conditions or associated rectovaginal fistula. In patients with profound pelvic fibrosis abdominoperineal resection with a definitive stoma is the best option.