Surgical horror story in colorectal surgery

Anastomotic leakage after colorectal surgery is a serious complication, particularly in high-risk patients with advanced disease and morbid obesity. We present the case of a 56-year-old woman with a body mass index of 48, history of multiple abdominal surgeries, and diagnosis of sigmoid adenocarcinoma. She initially underwent laparoscopic sigmoidectomy with colorectal anastomosis at another institution. The postoperative course was complicated by fever, abdominal pain, and fecal discharge through the wound and drain. Upon transfer to our hospital, imaging and rectosigmoidoscopy revealed a 40% anastomotic dehiscence associated with an enterocutaneous fistula due to an unintended colonic pexy. During emergency surgery, no fecal peritonitis was found because the enterocutaneous fistula had diverted the total intestinal output externally. The procedure consisted of dismantling the fistula, resecting the ischemic segment of the descending colon, and constructing a terminal colostomy. The patient recovered hemodynamically stable and was referred for adjuvant chemotherapy given the high risk of recurrence. In this case, the unintended colonic pexy ultimately functioned as a protective colostomy and proved to be life-saving. This report emphasizes the importance of preoperative optimization in obese, high- risk patients and highlights the value of timely reintervention and multidisciplinary management in reducing morbidity and mortality in colorectal surgery.