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Erschienen in:
01.09.2011 | The Last Image
Amelioration of chronic pelvic sepsis secondary to a non-collapsible pelvic cavity using a gracilis rotational flap
Erschienen in: Techniques in Coloproctology | Ausgabe 3/2011
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An 18-year-old female presented with a 4-year history of pelvic sepsis secondary to Crohn’s disease of her ileoanal pouch. After pouch removal, pelvic sepsis persisted. Computed tomography and MRI scans (Fig. 1a, b) showed a large presacral cavity with a fistula tract through the right gluteus muscle and a dehisced anal canal stump. Management with wound packing, antibiotics, and hyperbaric oxygen was unsuccessful. The final attempt to treat the sepsis was interposition of the right gracilis muscle (Figs. 2–5). The sepsis slowly resolved (Fig. 6).
Fig. 1
a, b: Axial CT (a) and MRI (b) scans show the presacral cavity (white arrow) and the transgluteal fistula tract (yellow arrow)
Fig. 2
The right gracilis muscle was harvested using the two incisions seen here. The origin of the muscle is at the body of the pubis and inferior pubic rami. The insertion of the muscle is freed from the medial aspect of the proximal tibia
Fig. 3
A tunnel was created so that the gracilis muscle could be passed into the pelvic cavity. The handle of the instrument seen here is at the origin of the gracilis muscle, and the tip is through the existing gluteal fistula
Fig. 4
The full extent of the rotated gracilis muscle that will be used to fill the pelvis is shown here. This was then placed into the pelvic cavity shown in Fig. 1
Fig. 5
A distal mucosectomy of the anal canal was done and the sphincter muscles closed primarily. The stitch (white arrow) shown in the left buttock region was placed transcutaneously to secure the gracilis muscle that traversed the pelvic cavity form the right side of the pelvis where it had been tunneled
Fig. 6
Six months later, only a tiny sinus tract remained in the right gluteus region and the patient was asymptomatic
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