Robot-Assisted Ultra-Low Anterior Resection for Rectal Neuroendocrine Tumors after Severe Perineal Tears: A Case Report.

Abstract

Introduction: Surgical repair of severe perineal tears is required immediately postpartum. Owing to their low prevalence, the post-treatment course of severe tears is not well known. Herein, we report a rare case of a young woman who underwent robot-assisted curative resection with anal preservation for a rectal neuroendocrine tumor (NET) incidentally discovered following a severe perineal tear.

Case presentation: A 29-year-old woman experienced a severe perineal tear during the first vaginal delivery, which led to the incidental discovery of a 20-mm rectal NET. Four months after the perineal tear, the gynecology and digestive surgery teams ensured that the tear wound had completely healed and anal function was preserved. The patient underwent robot-assisted ultra-low anterior resection with lymph node dissection. The procedure was successfully completed, preserving anal function, and histopathology confirmed an NET (G2, pT2N2aM0, pStage IIIB). The patient recovered smoothly and was discharged on the seventh postoperative day.

Conclusions: Rectal surgery after severe perineal tears may be associated with scarring and fibrosis around the rectum, and precautions should be taken at the time of rectal dissection. Depending on the tumor condition, it may be advisable to perform rectal surgery several months after the tear rather than immediately after treatment for the tear.