Abstract
IntroductionClosing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim.Case presentationWe describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour.ConclusionWe report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.
Highlights
Closing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy
Closing the pelvic peritoneum to prevent the small bowel falling into the pelvis following surgery for local recurrence of rectal cancer can be difficult because sufficient native tissue is unavailable
A variety of abdominopelvic partitioning procedures designed to prevent the small bowel from coming into contact with the pelvic floor or the presacral area are described in the literature [1]
Summary
In cases where primary closure of the pelvic peritoneum is not feasible, the use of SURGISIS as a sling to hold the small bowel out of the pelvis can be performed without infective complications and adds minimum morbidity during the postoperative period. The use of SURGISIS as a pelvic sling has not been reported before and we suggest that future studies should compare SURGISIS slings to other abdominopelvic partitioning procedures. Written informed consent was obtained from both patients for publication of this case report. 4. Kavanah MT, Feldman MI, Devereux DF, Kondi ES: New surgical approach to minimize radiation-associated small bowel injury in patients with pelvic malignancies requiring surgery and high-dose irradiation. 6. Dasmahapatra KS, Swaminathan AP: The use of a biodegradable mesh to prevent radiation-associated small-bowel injury.
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