Giant squamous cell carcinoma as a complication of a chronic enterocutaneous fistula: complex parietal reconstruction

Abstract

Treatment of an enterocutaneous fistula is complex and may require multidisciplinary management, especially when associated with a neoplastic process. Here, we describe the case of a 59-year-old patient with a squamous cell carcinoma that had invaded the abdominal wall through a chronic enterocutaneous fistula identified 30 years ago. We combined parietectomy with small intestine and colon resection and inguinal lymphadenectomy in order to obtain clear surgical margins. At the same time, plastic surgery involved the implementation of a large bioprosthesis and coverage with a vastus lateralis muscle free flap.

Keywords: Abdominal parietectomy; Bioprosthesis; Parietal squamous cell carcinoma.

Figure 1

A local view during preoperative vacuum therapy. Σ: enterocutaneous fistula, X: old drain hole in the left flank.

Figure 2

Preoperative CT scan. Σ: A tumour infiltrating the sheath of the rectus abdominis, φ: a tumour infiltrating the left oblique muscle and X: a carcinomatosis lesion infiltrating the small intestine.

Figure 3

Intraoperative photographs. (A) Plot of the resection area and free flap harvesting zone (Ω). (B) En bloc resection of the abdominal wall and the small intestine. (C) Implementation of bioprostheses (ø) with one ileostomy (Σ) and one colostomy (X) through the prostheses. (D) Local view at the end of surgery.

Figure 4

Postoperative CT scan and lower gastrointestinal endoscopy. (A) A CT scan highlighting the bioprostheses in the abdominal wall (Ω) and the colocolonic fistula directed to the abdominal wall (Σ). (B) Lower gastrointestinal endoscopy showing the partially covered colonic stent.

Figure 5

Histological analysis of the surgical specimen.