Soheila Aminimoghaddam, Nafisseh Hivehchi, Marjan Ghaemi, Arefeh Eshghinejad, Maryam Yazdizadeh,
Article Info
Keywords:
Bakri balloon
Pelvic exenteration
Cervical cancer
Abstract
Introduction and importance: Total pelvic exenteration is the choice treatment for locally advanced or recurrent cervical cancers. However, the procedure is usually associated with serious complications. One of the most common complications is “empty pelvic syndrome”. In this case report, we described a novel method to inves tigate its efficacy in prevention of empty pelvic syndrome. Case presentation: A 51-year-old woman presented with recurrent cervical cancer underwent TPE after chemo radiotherapy. After removing the organs of the pelvic cavity, a silicone-made Bakri balloon was placed in there through the laparotomy incision. The balloon was removed 5 days later through the vaginal canal. She was followed for 6 months after the surgery and did not experience neither complications nor the recurrence of the cervical cancer. Clinical discussion: We intended to use a novel technique by placing a Bakri balloon in the pelvic cavity after the total pelvic exenteration. The silicone-made balloon creates an appropriate physical barrier to support colon and small intestine loops and other pelvic contents. Conclusion: Bakri balloon, which has been used to control the post-partum hemorrhage, can be a useful tool to provide a physical barrier to prevent the descending of intestinal loops and a breeding ground for reconstruction of the pelvic floor.
Introduction
Cervical cancer is the most common gynecological cancer in resource-poor countries, with 270.000 deaths annually worldwide [1,2]. Cervical cancer is mainly resulted from chronic infection by high-risk HPV [3].
Persistent infection of the cervical epithelium by high-risk HPV can lead to cervical intraepithelial neoplasia which may progress to invasive cervical cancers including squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, and other rare histotypes [4].
Common treatments for cervical cancer include surgical resection, chemotherapy, radiotherapy, or a combination of these modalities. In addition, Molecular biology and targeted therapies are comprehensively investigated in metastatic diseases. However, it appears the therapies focusing on either the microenvironment (i.e., angiogenesis) or papil lomavirus biology are unable to inhibit cervical tumor growth [5].
Total pelvic exenteration has been one of the options of choice in patients with recurrent or locally invasive cervical cancer. It is a radical surgical procedure to remove the gynecological organs and urological organs including the bladder, urethra, rectum, anus, vagina, cervix, uterus, fallopian tubes, ovaries, and sometimes the vulva [6].
TPE is a safe procedure with a roughly 0.5–2 % mortality rate [7]. Nevertheless, the morbidity rate rises up to 51 %. The complications are fistulas in the gastrointestinal tract, insufficiency of anastomosis, and wound complications in most cases [8].
It is reported that above 6 % of cases experience perineal prolapse and in 15 % of the cases fistula occurs after the surgery if a pelvic floor reconstruction method is not performed [9].
“Empty pelvis syndrome” is one of the major complications of this radical surgery, which occurs due to the vacant space in the pelvic cavity after total pelvic exenteration. The probability of sepsis, wound com plications, bowel obstruction and fistulas rise because of the collection of pelvic fluid and descending of the intestinal loops in the pelvic cavity
To prevent the sequalae’s of the empty pelvic syndrome, several techniques have been used. However, none has gained ubiquitous acceptance [11]. Some of the methods application of artificial materials such as polypropylene mesh, degradable mesh [10], prostethic implants [12] or myocutaneous flap reconstruction [13].
Regarding the low 5-year survival rate following the above mentioned surgery (41 %) [8], in this report we put a new method into perspective by placing Bakri balloon in the pelvic cavity after total pelvic exenteration so as to see if it allows a successful management of TPE and empty pelvic syndrome. This report presents the efficacy of the Bakri balloon as a visceral replacement for occupying the pelvic cavity.
