You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
posterior pelvic exenteration ( ppe ) is a significant procedure to achieve complete tumor removal within the pelvis in the surgical treatment of primary advanced ovarian cancer or , less frequently , of recurrent disease . in most cases of this supralevator - type resection a low colorectal anastomosis , which is usually located 4 to 7 cm above the anocutan line , is possible because the infraperitoneal rectum is preserved from invasion by the pelvic mass .
current studies , including a review of literature , report a frequency of clinically significant anastomotic leakage in up to 10% , mostly less than 4% .
anastomotic dehiscence is associated with an increased early and long term morbidity and mortality , mostly accompanied by a surgical re - intervention , a longer hospitalization , an impairment of anorectal function , and a delay of subsequent chemotherapy [ 1 - 5 ] .
a 44-year old woman ( gravida 2 , para 1 ) underwent an optimal debulking surgery defined as complete tumor removal because of ovarian cancer figo stage iiic characterized by a pronounced intraperitoneal tumor spread .
midline laparotomy includes the following procedures : posterior pelvic exenteration ( ppe ; en bloc resection of inner genitals , about 19 cm rectosigmoid and complete pelvic peritoneum ) , infragastric omentectomy , appendectomy , extensive deperitonealization of the right hemidiaphragm , removal of multiple peritoneal tumor deposits and , finally , a systematic pelvic and para - aortic lymph node dissection .
the anastomotic doughnuts were complete and , additionally , the integrity of anastomosis was tested by insufflation of methylene blue - stained saline solution .
histopathology revealed a serous adenocarcinoma originating from the ovaries ( tnm - classification : pt3c , pn1 [ 5/97 ] , pm1 lym [ 1/19 ] , l1 , v0 , g3 ) .
the patient 's postoperative recovery was uneventful over the next few days and her condition improved continuously . however , increased inflammation indicating values , leukocytes and c - reactive protein , decreased only gradually .
after exclusion of possible foci a ' blind ' antibiotic treatment with cefuroxim and metronidazol was initiated on postoperative day 5 . despite this therapy ,
the patient had complained of fever up to 38.5 every afternoon since the eighth day . on day 11 after surgery ,
leukocytes and c - reactive protein increased considerably in comparison with the values of the day before ( 11.3  15.510/l ; 146.2 
an abdominopelvic computer tomography scan revealed infected lymph cysts surrounding the iliac vessels on both sides ( right , 76 cm ; left , 87 cm ) , but there was no suspicion of any anastomotic leak .
regardless of the continued high temperature during the afternoon , the patient felt relatively comfortable ; her bowel function was inconspicuous .
one day later , the causal diagnosis of an anastomotic dehiscence , located 5 cm above the anocutan line , was demonstrated by transvaginal ultrasound ( fig .
considering the patient 's condition , it was decided to attempt an endo - sponge assisted treatment ( fig .
a parenteral nutrition for two weeks was initiated and during the nine - day transanal vacuum therapy the sponge was changed twice .
subsequently , a bowel rinsing was semi - weekly performed over the following two weeks ( fig .
the anastomotic leakage healed successfully and the patient recovered uneventfully and was discharged on postoperative day 29 .
the first cycle of combination chemotherapy consisting of caboplatin auc 5 and paclitaxel 175 mg / m2 could be applied two weeks later .
the application of transvaginal ultrasound to diagnose a leakage of colorectal anastomosis has not been previously described .
the diagnostic criteria are the discontinuity of the rectal wall and an oscillating fluid flow between the bowel lumen and a surrounding hyperechogenic fluid collection , which is induced by pushing in the bowel wall by means of the ultrasound probe . in our opinion
, ultrasound diagnostics should be integrated early in the diagnostic management of divergences from the expected course after any surgery .
further points of interest are the use of protective stoma to prevent anastomotic leakage and the treatment options of this complication in patients receiving ppe for ovarian cancer .
the authors of a multicenter study concluded that a temporary protective stoma should be considered only exceptionally , because the rates of " anastomotic fistula " were the same with and without stoma , respectively ( 8.5% vs. 8.2% ) .
in addition , there are only a few published studies including small numbers of patients .
if an anastomotic dehiscence occurs , a re - operation to secondarily create a covering ileo- or colostomy or to drain the pelvic cavity in order to prevent severe septic complications is necessary in the majority of these cases .
the endoluminal vacuum therapy of anastomotic leakages has been increasingly applied following resections in both the upper and lower gastrointestinal tract over the last few years .
this approach can be integrated into both a surgical and conservative treatment regime , but the therapeutic effectiveness has not been verified by randomized clinical trials .
reports about the application of this method in the field of gynecologic oncology are absent .
our case demonstrates , firstly , that anastomotic leakage of colorectal anastomosis can be obviously diagnosed by transvaginal ultrasound and , secondly , in selected cases characterized by a small leak size and a local peritonitis confined to the pelvis , an attempt of conservative management based on transanal vacuum therapy is justified and may avoid creating a secondary diverting stoma .
anastomotic leakage is a very significant complication after posterior pelvic exenteration and a major cause of postoperative morbidity and mortality . 
 we present a patient who underwent an optimal debulking surgery for an advanced stage ovarian cancer ( figo iiic ) . on postoperative day 12 , 
 transvaginal ultrasound revealed an anastomotic dehiscence following an unsuspicious computer tomography scan the day before . 
 the patient was successfully managed by transanal vacuum therapy without re - laparotomy within a period of 4 weeks after diagnosis . 
 we conclude that high - resolution transvaginal ultrasound is a crucial method in the management of complications after surgery and even allow diagnosing leakages of colorectal anastomosis . in selected cases characterized by a small leak size and a local peritonitis confined to the pelvis 
 a transanal vacuum therapy may avoid both surgical re - intervention and creating a secondary diverting stoma .