Use of the bladder as an abdominopelvic partition

In patients required to undergo abdominoperineal resection, optimal results are obtained only when small bowel loops are prevented from entering the pelvis postoperatively. If small intestine is lodged within the pelvic cavity, fistulization or small-bowel obstruction from fixed twisted bowel loops may occur. Also, postoperative radiation therapy is likely to permanently damage the small bowel. In order to prevent these long and short term complications, the bladder may be used as an abdominopelvic partition to exclude abdominal contents from the pelvis. When the pelvic defect is large, the space beneath the bladder is filled with a pedicle flap of greater omentum. The results of this technical approach is reported in 2 patients; uniformly good results have been seen in 10 patients. These patients had normal urinary tract function after bladder suspension as an abdominopelvic partition. Also, a benign, postoperative course and long-term, normal small-bowel function without fistulization or obstruction resulted.