Pneumoretroperitoneum after a STARR Procedure Performed One Year after a Posterior Colporrhaphy: A Case Report and Review of the Literature

Transanal rectal resection with a stapling instrument (STARR) has been shown to be effective and safe for the treatment of obstructed defecation syndrome (ODS). Nevertheless, the wide range of complications described in the literature necessitates a rigorous patient selection and a tailored approach for the management of complications. We present here a case of pneumoretroperitoneum which occurred after a STARR procedure for ODS was performed nearly a year after previous anterior and posterior colporrhaphy. The diagnostic workup did not reveal a staple-line defect. Laparoscopy did not show any intra-abdominal pathology. The symptoms resolved under oral antibiotics. The patient was discharged on day 10 after admission. Scarring in the rectovaginal septum from a colporrhaphy 1 year earlier might have contributed to a suboptimal staple-line closure during the STARR procedure, leading to a pneumoretroperitoneum. We discuss this complication and provide a brief review of the literature.

Repair of Posterior Vaginal Wall Defect Using Biologic Graft for Stage III-POP-Q Pelvic Organ Prolapse in a Patient with History of a J-Pouch

Surgical correction is considered in women with symptomatic pelvic organ prolapse (POP). There is an expected increase in the prevalence of surgical correction due to an aging population within the United States. Individuals with previous colorectal surgery present a unique challenge considering the changes in pelvic anatomy. This case discusses the challenges of posterior colporrhaphy in a patient with previous, remote J-pouch surgery. In traditional posterior colporrhaphy, randomized controlled trials have not shown any benefit of graft augmentation (Maher, 2016). However, the utilization of a biologic graft to improve anatomical correction is discussed in this unique case. Short term anatomical success was obtained without immediate complications in the postoperative period. In a patient with a history of ulcerative colitis with colorectal resection and a J-pouch, surgery can be challenging due to alterations of pelvic anatomy. Modification of the standard surgical approach may be required to achieve success.