The use of inferior gluteus perforator (IGAP) flap reconstruction for vaginal metastasis of rectal cancer: a case report

Abstract

Vaginal metastasis from colorectal adenocarcinoma can occur months after the resection of the primary tumor. Most of the time, bleeding is the bothersome symptom. The optimal treatment involves surgical excision followed by reconstruction to prevent the lymphatic networks in the rectovaginal septum serving as a potential route of spread. There have been a number of successful vaginal reconstructive options reported. We describe a 32-year-old woman who had previously undergone an abdominoperineal resection for rectal cancer and was now suffering with rectal adenocarcinoma vaginal metastases. An inferior gluteus perforator flap (IGAP) repair was carried out following posterior vaginectomy after a comprehensive multidisciplinary examination. This flap can be used to address perineal dead space as well as to reconstruct the neovaginal area, eliminating the need for a second flap and significantly reducing donor morbidity. The lesson from this case is that vaginal metastases can still develop even after the primary colorectal tumor has been removed. One-step surgical excision and perineal repair can result in an enhanced quality of life and a good prognosis.

Keywords

• vaginal metastasis
• rectal cancer
• igap
• vaginal reconstruction