Introduction: Enterocutaneous fistulas (ECFs) can be caused by abscess formation at the site of anastomotic leakage (AL) after surgery. Rectocutaneous fistula following low anterior resection (LAR) is rare, and medical management of ECFs is usually the initial treatment. We report a case of rectocutaneous fistula after laparoscopic LAR, which was successfully treated, for the first time, with a transanal endoscopic operation (TEO). Case Presentation: A 58-year-old man presented with a history of hypertension, benign prostatic hyperplasia, peptic ulcer, and recent diagnosis of rectal cancer. The patient underwent laparoscopic LAR with coloanal anastomosis complicated with AL. He then underwent transanal repair of the anastomosis site and laparoscopy with ileostomy. Six months later, he complained of a painful mass lesion over the right buttock that relieved after passing purulent fluid and feces. Colonoscopy and imaging revealed a fistula for which he received antibiotics and wound incision and drainage. He also underwent TEO repair of the rectal fistula, recovered well, and was discharged from hospital. On follow-up 7 months later, there was no recurrence or sign of localized infection. Conclusion: TEO repair may be an effective method for managing rectocutaneous fistula after LAR complicated with AL instead of a major operation.

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