BACKGROUND: Anastomotic leakage is a major cause of postoperative morbidity after rectal surgery. However conservative treatment of anastomotic leakage seems to be possible in patients who have no occurrence of generalized peritonitis. This report describes radiological management of anastomotic leakage following anterior resection of the rectum. METHOD: During the postoperative timing, symptomatic patients (fever, abdominal pain, rectal hemorrhagia, water diarrhea) or those with elevation of C-protein reactive, performed water- soluble contrast enema. When the examination showed an anastomotic leakage, radiological assisted placement of transrectal catheter into the abscess cavity: van Sonnemberg drainage, has been established as the routine treatment in patients with major leaks of extraperitoneal rectal anastomoses in the absence of sepsis. RESULTS: From January 2003 until June 2009, 65 patients were submitted to radiological assisted placement of van Sonnenberg drainage after anterior resection of the rectum: we excluded 6 patients of chronic fistula and 1 patient positioning failed due to technical difficulties. We consider 58 patients: 40 male and 18 female, mean age 66,2 years old (DS 11,5) mean BMI 24,50 SI (DS 3,2). 33 patients with anastomotic leakage after LAR without ostomy: 21 patients (63,6%) after transanal drainage needed a laparotomy and ileo-colostomy, 12 patients (36,4%) were treated successfully only positioning a van Sonnenberg transanal drainage. 25 patients with a symptomatic pelvic abscess after LAR with ostomy: 21 patients (84%) have a good resolution of presacral abscess and 4 patients (16%) needed a further laparotomy. CONCLUSIONS: van Sonnenberg drainage represents a new simple and inexpensive tool in treatment of anastomotic leakage following rectal surgery. No mortality rate and acceptable average hospital stay after fistula diagnosis (mean of 18 days in conservative treatment after van Sonnemberg placement) and the good resolution of presacral abscess in patients with stoma, are very interesting results. Letteratura esistente ed apporto specifico del lavoro presentato :  Vannelli A, Battaglia L, Poiasina E, et al. The art of decision-making in surgery. To what extent does economics influence choice? Chir Ital. 2006;58(6):  Leo E, Belli F, Miceli R, et al. Distal clearance margin of 1 cm or less: a safe distance in lower rectal cancer surgery. Int J Colorectal Dis. 2009;24(3):  Heine JA, Rothenberger DA. Cost-effective management of colon and rectal cancer. World J Surg. 1991;15(5):  Corbara F. Not only DRG (without new "Quality" the recently introduced hospital financing system risk failure). G Ital Cardiol. 1996;26(4): Alberto Vannelli, Paolo Boati, Luigi Battaglia, Elia Poiasina, Ermanno Leo. Division of General Surgery B Foundation IRCCS “National Institute of Tumour”, Milan Italy 2 nd - 4 th December 2009 BENIGN COLORECTAL DISEASES St.Gallen, Switzerland Radiological assisted treatment of anastomotic leakage in colorectal surgery A Da gennaio 2003 a giugno resezione anteriore del retto 126 Fistole totali Immediate 98 Tardiva 28 Sepsi e intervento 61 Posizionamento Van Sonnenberg 37 Insuccesso 1 No stomia 27 Stomia al primo intervento 9 Secondo intervento 0 Risoluzione 9 Secondo intervento e stomia 16 Risoluzione senza stomia 11 Posizionamento Van Sonnenberg 28 Stomia al primo intervento 17 Secondo intervento e stomia 3 No stomia 2 Fistola cronica 6