[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-461725-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-461725-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","colon-perforation-caused-by-a-transanal-drainage-tube-after-robot-assisted-low-anterior-resection-a-case-report","Colon Perforation Caused by a Transanal Drainage Tube After Robot-Assisted Low Anterior Resection - A Case Report","","Transanal drainage tubes (TDTs) are used after low anterior resection to lower intraluminal pressure around the anastomosis, yet bowel perforation from TDT placement is extremely rare. This case report describes a 71-year-old man with rectal cancer who underwent robot-assisted laparoscopic low anterior resection with laparoscopic-guided TDT positioning. On postoperative day 4, abdominal pain and peritonitis developed; computed tomography showed free air and localized fluid near the tube tip. Emergency surgery confirmed TDT penetration of the proximal colon wall, treated with primary repair and a diverting loop ileostomy, leading to an uneventful recovery. ",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/colon-perforation-caused-by-a-transanal-drainage-tube-after-robot-assisted-low-anterior-resection-a-case-report/461725/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/colon-perforation-caused-by-a-transanal-drainage-tube-after-robot-assisted-low-anterior-resection-a-case-report/461725.png","ImageObject",300,407,{"name":42,"@type":43},"pixelkiddo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why are transanal drainage tubes (TDTs) used after low anterior resection?","Question",{"text":63,"@type":64},"TDTs are commonly used to reduce intraluminal pressure around the anastomosis and protect the surgical site. Their routine benefit is debated, but they are used in some institutions.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What symptoms and imaging findings prompted emergency reoperation in this case?",{"text":68,"@type":64},"On postoperative day 4, the patient developed abdominal pain and signs of peritonitis. Computed tomography demonstrated free air and a localized fluid collection near the TDT tip.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the complication managed once TDT-related perforation was confirmed?",{"text":72,"@type":64},"Laparoscopic exploration confirmed TDT penetration of the proximal colon wall. The team performed primary suture repair of the perforation and created a diverting loop ileostomy, after which the patient recovered without further complications.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},461725,1791032260,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":124,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},962090883892,"https://ap-avatar.wpscdn.com/avatar/e00115db34f3e0f11b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1790152879550218658","Review began 11/24/2025  \nReview ended 12/05/2025  \nPublished 12/10/2025  \n© Copyright 2025  \nHazama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98916  \nOpen Access Case Report  \nColon Perforation Caused by a Transanal Drainage Tube After Robot-Assisted Low Anterior Resection: A Case Report  \nHiroyuki Hazama 1, Kohei Koido 1, Kazumasa Nakamura 1, Takeshi Oshima 1 , Kou Ohata 1  \n1. Gastrointestinal Surgery, Shizuoka General Hospital, Shizuoka, JPN  \nCorresponding author: Hiroyuki Hazama, [hiroyuki-hazama@i.shizuoka-pho.jp](hiroyuki-hazama@i.shizuoka-pho.jp)  \nAbstract  \nTransanal drainage tubes (TDTs) are commonly used after low anterior resection to reduce intraluminal pressure around the anastomosis. Although associated complications are usually minor, bowel perforation related to TDT placement is exceedingly rare. We report the case of a 71-year-old man who underwent robot-assisted laparoscopic low anterior resection for rectal cancer. A TDT was inserted intraoperatively, and its position was adjusted under laparoscopic guidance. Abdominal radiography performed on postoperative day (POD) 1 showed that the tube tip was located approximately 7 cm proximal to the anastomosis. On POD 4, the patient developed abdominal pain and signs of peritonitis. Computed tomography demonstrated free air and localized fluid collection near the tube tip. Anastomotic leakage or TDT-induced bowel perforation was suspected, and emergency reoperation was undertaken. Laparoscopic exploration confirmed that the TDT had penetrated the colon wall proximal to the anastomosis, resulting ina perforation. Primary suture repair of the perforation and creation of a diverting loop ileostomy were performed. The postoperative course was uneventful, and the patient recovered without further complications. This case highlights an uncommon but serious complication associated with TDT placement and underscores the importance of meticulous intraoperative positioning, close postoperative monitoring, and prompt evaluation when unexpected abdominal symptoms arise.  \nCategories: Other, General Surgery, Gastroenterology  \nKeywords: colon perforation, iatrogenic injury, low anterior resection, rectal cancer, robot-assisted surgery, transanal drainage tube, tube-related complication  \nIntroduction  \nAnastomotic leakage (AL) remains one of the most critical complications following low anterior resection (LAR) for rectal cancer. Transanal drainage tubes (TDTs) have been used in some institutions with the intention of reducing intraluminal pressure and protecting the anastomosis, although their clinical value remains controversial. The commonly cited mechanism, partial relaxation of the anal sphincter and continuous decompression of the rectal vault, has been challenged, and practice patterns differ substantially across regions. In particular, intraluminal tubes are generally not recommended in the United States, where their theoretical benefits are considered unproven, and concerns about device-related harm have been raised.  \nConversely, several recent studies from Asian and European cohorts have reported that TDT placement may reduce the risk of AL in selected patients. A randomized clinical trial by Zhao et al. demonstrated significantly lower AL rates after laparoscopic LAR with TDT use [1] . A network meta-analysis by Yeow et al. similarly suggested potential benefit over no drainage or diverting stoma [2], and a recent systematic review by Tamura et al. further supported the possible effectiveness and safety of TDTs [3] . However, these findings are not universally accepted, and the overall quality and generalizability of the evidence remain heterogeneous.  \nAlthough most reported adverse events are minor, such as discomfort or bleeding,","cbCait3eD3YpuFjX","https://ap.wps.com/l/cbCait3eD3YpuFjX","pdf",6875906,"English","# Introduction\n# Case Presentation","[{\"question\":\"Why are transanal drainage tubes (TDTs) used after low anterior resection?\",\"answer\":\"TDTs are commonly used to reduce intraluminal pressure around the anastomosis and protect the surgical site. Their routine benefit is debated, but they are used in some institutions.\"},{\"question\":\"What symptoms and imaging findings prompted emergency reoperation in this case?\",\"answer\":\"On postoperative day 4, the patient developed abdominal pain and signs of peritonitis. Computed tomography demonstrated free air and a localized fluid collection near the TDT tip.\"},{\"question\":\"How was the complication managed once TDT-related perforation was confirmed?\",\"answer\":\"Laparoscopic exploration confirmed TDT penetration of the proximal colon wall. The team performed primary suture repair of the perforation and created a diverting loop ileostomy, after which the patient recovered without further complications.\"}]","Colon Perforation Caused by a Transanal Drainage Tube After Robot-Assisted Low Anterior Resection - A Case Report | PDF",1790762250,25]