Iranian Journal of Colorectal Research

Iranian Journal of Colorectal Research

The Use of Inferior Gluteus Perforator (IGAP) Flap Reconstruction for Vaginal Metastasis of Rectal Cancer: A Case Report

Document Type : Case Report

Authors
Adianto Nugroho 1
Elisabet Kinanthi 2
Sara Triatmoko 3
Indah Jamtani 1
1 Digestive Surgery Division, Department of Surgery, Fatmawati Central General Hospital, Jakarta, Indonesia
2 Department of Surgery, Fatmawati Central General Hospital, Jakarta, Indonesia
3 Plastic Surgery Division, Department of Surgery, Fatmawati Central General Hospital, Jakarta, Indonesia
10.30476/acrr.2023.97169.1163
Abstract
Introduction: Colorectal adenocarcinoma metastasis to the vagina can occur months after the primary tumor resection. Most of the time, bleeding is the main alarming symptom. The optimal treatment involves surgical excision followed by reconstruction to prevent the lymphatic networks in the rectovaginal septum from serving as a potential route of spread. Several successful vaginal reconstruction options have been reported. 
Case Presentation: We describe a 32-year-old woman who had previously undergone an abdominoperineal resection for rectal cancer and was now suffering from rectal adenocarcinoma vaginal metastasis. An inferior gluteus perforator flap (IGAP) repair was carried out following posterior vaginectomy after a comprehensive multidisciplinary examination. This flap can address perineal dead space and 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 removing the primary colorectal tumor. 
Conclusion: One-step surgical excision and perineal repair can result in an enhanced quality of life and a good prognosis.
Keywords
Colorectal Neoplasms
Vagina
Perforator Flap
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Iranian Journal of Colorectal Research
Volume 11, Issue 1
Winter 2023
Pages 42-45