Use of a tissue expander and a polyglactic acid (Vicryl) mesh to reduce radiation enteritis: case report and literature review

Abstract

Management of stage IV rhabdomyosarcoma comprises systemic chemotherapy with local control by conservative surgery and radiotherapy. Abdominal radiotherapy may lead to radiation enteritis causing such serious morbidity as malabsorption, fistulae or stricture formation. The risk increases with the dose of radiation and length of bowel involved. Various methods have been utilised to displace the bowel from the radiation field. Usually these are applied in patients requiring pelvic irradiation. We report a case of metastatic alveolar rhabdomyosarcoma requiring radiotherapy to the right renal bed. Effective displacement of small bowel from the tumour site was achieved by a combined use of a tissue expander and Vicryl mesh. There were no complications from the surgery. This is the first report discussing combined use of a tissue expander and Vicryl mesh to aid radiotherapy to the renal fossa in a paediatric patient.

The Small Bowel in Its Hammock: How to Avoid Irradiation Thanks to the Sigmoid

“…16,18 The combination of a tissue expander and a polyglactic acid mesh in a 9-year-old boy relapsing from alveolar rhabdomyosarcoma has allowed 95% of the intestine to be spared from total irradiation. 17 In the early adult experience, compression of the ureters, the bladder, or the iliac vessels and infections with abscess formation and fistulization have been related to the long-term placement of large tissue expanders in the pelvis. Dislodgement, spontaneous deflation, and extrusion of expander have also been reported.…”

“…[9][10][11][12][13][14][15] In children, few articles have reported the use of a mesh or a tissue expander to compartmentalize the abdomen and separate it from the pelvis. [16][17][18][19] Herein, we describe the use of the sigmoid colon to function as a hammock by the laparoscopic approach to avoid small bowel irradiation and subsequent consequences.…”

Laparoscopic insertion of pelvic tissue expander to prevent radiation enteritis prior to radiotherapy for prostate cancer

“…Deep vein thrombosis with pulmonary embolism and constipation due to obstructive defecation have been reported[11,12]. More recent reports using smaller implants show them to be associated with fewer complications[13-17]. Infection, with abscess formation and fistulisation, have been reported to occur in up to 7% of cases[18].…”