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.