Delayed reconstruction of the bladder and rectum after evisceration of the pelvic organs in patients with relapse of malignant neoplasms and radiation injuries (2 clinical observations)

Abstract

The study presents two clinical observations of delayed reconstructive surgeries: 1) in a patient with recto-bladder fistula formed after a course of external beam therapy due to recurrent prostate cancer; 2) in a patient with progressing cervical carcinosarcoma, tumor invasion in the bladder wall, and metastases in the rectoperineal lymph nodes. Absence of standards of care, algorithms of diagnostic and surgical manipulations for this patient category creates a need for personalized approach to the stated problems. An interdisciplinary meeting allows to realize a plan of surgical help for these patients to address oncological process and complications of its treatment. At the reconstructive stage, we used techniques of formation of a new continent heterotopic reservoir from the ileocecal segment and coloanal anastomosis. The presented clinical observations are interesting due to delayed stage of reconstructive interventions which in the absence of progression of the main disease allows to perform correcting operations to improve patients’ quality of life.

Keywords

• late radiation injuries
• urinary-rectal fistula
• cervical carcinosarcoma
• evisceration of pelvic organs
• reconstructive surgery
• continental heterotopic urinary reservoir