Double Rectum Sign: Anastomotic Leakage

A 41-year-old patient presents a prolonged ileus with abdominal tendernesss even days after an anterior resection with total excision of the mesorectum and latero terminal colorectal anastomosis for a rectal adenocarcinoma. The laboratory results reveal elevated CRP levels. An abdomino-pelvic CT scan with low water-soluble opacification shows a leakage of the contrast media with individualization of a parietal defect next to the colorectal anastomosis (Figure 1), feeding a pre-sacral collection mimicking a rectal lumen in a “double rectum sign” appearance (Figure 2A & B).