Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration.

For most patients with bulky pelvic tumors, pelvic exenteration remains the only curative option. Although initially reported as a palliative procedure, nowadays it is rather performed with curative intent. Once the resectional phase is ended, a large defect will remain at the level of the pelvic diaphragm, predisposing to severe complications which are generically included under the name of empty pelvis syndrome. It has been widely demonstrated that this type of complication is associated with severe mortality, even if the patient is free of any pelvic recurrence. We present the case of a 56-year-old patient submitted to total pelvic exenteration for locally invasive previously chemo-irradiated cervical cancer who presented six months after surgery with a severe enteroperineal fistula. We decided to reoperate on the patient; intraoperatively we found recurrence on both pelvic walls and an enteroperineal fistula caused by tumoral invasion. We performed an intestinal resection with enteroenteral anastomosis. In order to isolate the intestinal loops from the unresectable pelvic recurrence, in the pelvis we placed three Foley catheters inflated with 60 ml of saline each, in order to hold the intestinal loops away from the pelvic wall. The postoperative course was uneventful. The urinary cathethers were removed after six weeks.