Cecum to pelvis technique: a simple and autologous solution to prevent postoperative complications in pelvic surgery

Background Empty Pelvis Syndrome, subsequent to the removal of pelvic organs, results in the descent of the small bowel into an inflamed pelvic cavity, leading to the formation of adhesions and subsequent small bowel obstruction. However, no effective measures have been previously described. Objective Describe a simple and autologous solution to prevent “Empty Pelvis Syndrome,” small bowel obstruction, and adhesions by utilizing the cecum to occlude the pelvis. Design Mobilization of the right colon to lower the cecum into the pelvic cavity to occlude the superior pelvic ring to some degree and changing the direction of the terminal ileum. Settings Hospital Universitario Fundación Jiménez Díaz, Department of General Surgery, Colorectal Service. Patients Eight anonymized patients were included in this study, each with varying colorectal pathologies. Patients were above 18 years old. Main outcome measures Percent of blockage of the superior pelvic ring produced by the descended cecum recorded in percentage; the amount of small intestine descended past the superior pelvic ring recorded in cm. Results The mobilization of the cecum achieved partial occlusion of the superior pelvic ring. The descent of the small bowel beyond this landmark ranged from 0 to 4.9 cm. Limitations Given the small number of patients included in this study, these results cannot be generalized to the whole of the population. A bladder emptying protocol prior to CT scans was not implemented, resulting in variations in measurements among patients. Conclusion The cecum-to-pelvis technique is a simple method that can serve as an autologous solution to EPS (enteropelvic fistula) and help reduce postoperative complications such as SBO (small bowel obstruction) and adhesions. It is not essential to completely occlude the superior pelvic ring to achieve successful outcomes.