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

Document Type : Case Report

Authors

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

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

References

1. Ng HJ, Aly EH. Vaginal metastases
from colorectal cancer. International
journal of surgery (London, England).
2013;11(10):1048-55.
2. Green JD, Evans JT, Ger R. Posterior
vaginectomy as a practice parameter
in rectal carcinoma. Diseases of the
colon and rectum. 1994;37(5):513-4.
3. Angeles MA, Martínez-Gómez C,
Martinez A, Meresse T, Gangloff D,
Ferron G. Vaginal reconstruction after
pelvic exenteration with a vertical
deep inferior epigastric perforator flap
in 10 steps. International journal of
gynecological cancer : official journal
of the International Gynecological
Cancer Society. 2020;30(12):2015-6.
4. Sadatomo A, Koinuma K, Horie H,
Lefor AK, Sata N. An isolated vaginal
metastasis from rectal cancer. Annals
of medicine and surgery (2012).
2016;5:19-22.
5. Funada T, Fujita S. A case of vaginal
metastasis from a rectal cancer.
Japanese journal of clinical oncology.
2010;40(5):482.
6. Korkmaz M, Eryılmaz MK, Kerimoğlu
Ü, Karaağaç M, Demirkıran A,
Demir ET, et al. Vaginal metastasis
in solid tumours: our four cases and
review of the literature. Journal of the
Egyptian National Cancer Institute.
2021;33(1):3.
7. Chasapi M, Maher M, Mitchell P,
Dalal M. The Perineal Turnover
Perforator Flap: A New and Simple
Technique for Perineal Reconstruction
After Extralevator Abdominoperineal
Excision. Annals of plastic surgery.
2018;80(4):395-9.
8. Brodbeck R, Horch RE, Arkudas A,
Beier JP. Plastic and Reconstructive
Surgery in the Treatment of
Oncological Perineal and Genital
Defects. Frontiers in oncology.
2015;5:212.
9. Cordeiro PG, Pusic AL, Disa JJ. A
classification system and reconstructive
algorithm for acquired vaginal defects.
Plastic and reconstructive surgery.
2002;110(4):1058-65.
10. Achauer BM, Braly P, Berman
ML, DiSaia PJ. Immediate vaginal
reconstruction following resection
for malignancy using the gluteal
thigh flap. Gynecologic oncology.
1984;19(1):79-89.
11. Nico Albano M, Louro JM, Brito I,
Ramos S. Perineal reconstruction
using an inferior gluteal artery
perforator flap after abdominoperineal
resection. BMJ case reports.
2019;12(9).
Authors’ Contribution
All authors have contributed to this manuscript
and reviewed and approved the final form of the
manuscript.
Informed Consent
Written informed consent was obtained from the patients.
Conflict of interest: None declared.

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