{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:55:23Z","timestamp":1791273323619,"version":"4.1.0"},"reference-count":11,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Robot\u2010assisted transanal minimally invasive surgery (TAMIS) is a safe and effective platform for the local excision of early rectal lesions. While postoperative complications such as bleeding or contained perforation are recognized, rapidly progressive retroperitoneal sepsis remains an exceedingly rare occurrence. A 56\u2010year\u2010old male underwent robot\u2010assisted TAMIS for a pT1 grade 1 rectal neuroendocrine tumor (NET). Despite successful circumferential excision and defect closure with sutures, the patient developed fever, hypotension, and rising lactaemia within 24\u2009hours. Computed tomography demonstrated localized gas in the total mesorectal excision (TME) plane. Due to hemodynamic instability and suspected retroperitoneal sepsis, a diagnostic laparotomy was performed, revealing purulent peritonitis and pneumoretroperitoneum. Concurrent flexible sigmoidoscopy revealed a healthy\u2010appearing TAMIS site. Management involved an end colostomy, laparostomy, and broad\u2010spectrum antibiotics after intra\u2010operative swabs grew extended\u2010spectrum beta\u2010lactamase (ESBL)\n \n E. coli<\/jats:italic>\n <\/jats:styled-content>\n . The patient was eventually discharged 15\u2009days post return to theater. This case highlights that retroperitoneal sepsis can develop after robotic TAMIS despite no local macroscopic evidence of perforation or necrosis. Clinicians should maintain a high index of suspicion for this condition in patients who deteriorate suddenly with septic shock, particularly when abdominal examination findings do not reflect the severity of systemic toxicity. Early surgical intervention with diversion and aggressive sepsis control is critical.\n <\/jats:p>","DOI":"10.1002\/ccr3.73425","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:47:06Z","timestamp":1788155226000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rare Finding of Retroperitoneal Sepsis Following Robot\u2010Assisted Transanal Minimally Invasive Surgery (\n TAMIS<\/scp>\n ): A Case Report and Review of the Literature"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2621-2530","authenticated-orcid":false,"given":"Jonathan","family":"Tiong","sequence":"first","affiliation":[{"name":"Department of General Surgical Specialties The Royal Melbourne Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-8248","authenticated-orcid":false,"given":"Khang Duy Ricky","family":"Le","sequence":"additional","affiliation":[{"name":"Department of General Surgical Specialties The Royal Melbourne Hospital Melbourne Victoria Australia"},{"name":"School of Medicine, Faculty of Health Deakin University Geelong Victoria Australia"},{"name":"Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6153-6755","authenticated-orcid":false,"given":"Annie Jiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgical Specialties The Royal Melbourne Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3039-6830","authenticated-orcid":false,"given":"Jean","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Department of General Surgical Specialties The Royal Melbourne Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3943-7862","authenticated-orcid":false,"given":"Dilshan","family":"Udayasiri","sequence":"additional","affiliation":[{"name":"Department of General Surgical Specialties The Royal Melbourne Hospital Melbourne Victoria Australia"},{"name":"Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinsp.2025.100613"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3393\/ac.2017.33.3.115"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.08.014"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11065-6"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15070932"},{"issue":"7","key":"e_1_2_13_7_1","first-page":"e99","article-title":"Complications of Transanal Endoscopic Microsurgery (TEMS): A Prospective Audit","volume":"12","author":"Bignell M.","year":"2010","journal-title":"Colorectal 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