2 | Case report
A 51-year-old female, with a history of advanced cervical cancer who was undergone total pelvic exenteration because of cancer recurrence.
Her cervical cancer was diagnosed as a 2B stage 1 year earlier for the first time. In the beginning, she underwent neoadjuvant chemoradiotherapy. After radiotherapy, her right kidney and right ureter were involved as a hydroureteronephrosis, and then right nephrostomy was placed in it.
In the middle of her last chemotherapy, abdominopelvic CT scan showed a mass of 40*74*132 mm originated from the cervix and invaded the vagina, rectum, ureter, bladder, pelvic wall, and piriformis muscle. So metastasis to her pelvic wall and other pelvic organs was diagnosed and candidate to total pelvic exenteration.
Total pelvic exenteration includes total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO), Trachelectomy, proximal vaginectomy, proctectomy, cystectomy, right proximal, and distal ureterectomy, left distal ureterectomy, and urhethrectomy were done. Left permanent colostomy after resection of the rectum and an ileal pouch as bladder was set. Then the pelvic floor was closed with peritoneum and omental pedicle flap to prevent visceral prolapse. Eventually, a bakri balloon was settled through the anus and was passed inflation port through the pelvic cavity then the balloon was inflated gradually with sterile normal saline solution up to the minimal volume (maximum capacity 500mL) that effectively fill the cavity. Pathology showed basaloid squamous cell carcinoma/poorly differentiated, Right pelvic wall mass (8*6*4 cm) involved by tumor and present lymphovascular invasion. IHC staining showed positive reactivity for P63 and showed negative reactivity for chromogranin and synaptophysin.
This report demonstrates the successful application of the large-volume Bakri balloon instead of a muscular flap for supporting omental pedicle flap.