A retrospective analysis was made of the complications from pelvic exenterations performed over the past 30 years for colorectal adenocarcinoma at the Roswell Park Cancer Institute. Seventy-five patients underwent exenteration, 51 for primary disease (PD) and 24 for recurrent disease (RD). Both total and posterior exenterations were included. Twenty of the fifty-one patients (39%) undergoing exenteration for PD developed severe complications, with an operative mortality rate of 6%. The most common complications were injuries to the ureter or bladder, intra-abdominal abscesses, and anastomotic leaks from the urinary diversion. After exenteration for RD, 12 of 24 patients (50%) developed severe complications, with an operative mortality rate of 4%. The most common major complication was an anastomotic leak from the urinary diversion; this occurred in 33% of all patients with RD (8/24). The authors conclude that, although exenteration for colorectal adenocarcinoma may be performed with a low operative mortality rate, patients must be carefully selected because the associated morbidity rate remains high.
Splenosis is a historically uncommon etiology for bowel obstruction. Autotransplanted splenic tissues following surgery or trauma of the spleen are known to occur in multiple locations of the abdominal cavity and pelvis. The small bowel mesentery is a blood vessel-rich environment for growth of splenic fragments. We present a case of a 36-year-old male patient who sustained a gunshot wound to his left abdomen requiring a splenectomy and bowel resection fifteen years prior to his presentation with small bowel obstruction requiring exploration, adhesiolysis, and resection of the mesenteric splenic deposit. Our aim in this report is to provide awareness of splenosis as an etiology for bowel obstruction, especially with increased incidence and survival following abdominal traumas requiring splenectomies. We also stress on the importance of history and physical examination to include splenosis on the list of differential diagnoses for bowel obstruction.
We performed a retrospective review of 68 patients who underwent pelvic exenteration for colorectal adenocarcinoma. Forty-seven patients had surgery for primary disease and 21 for recurrence. Clinical recurrence developed in 30 (44%) of 68 patients overall. Of these, 17 (57%) developed locoregional disease only as their first recurrence. This included nine (56%) of 16 patients with primary disease and eight (57%) of 14 patients with recurrent disease. Clinical recurrence developed in 16 (34%) of 47 patients with primary disease and 14 (66%) of 21 patients with recurrent disease. The overall 5-year survival rates were 43% and 20%, respectively. We conclude that locoregional recurrence remains a significant problem for primary or recurrent colorectal carcinoma even after radical pelvic surgery.
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