Management of a Pelvic Abscess and Abdominal Fistula after Palliative Total Pelvic Exenteration with Intraoperative Radiotherapy in Recurrent Rectal Cancer Without NPWT: A Case Report.
Hui Yang, Yuanyi Rui, Hong Chen
PMID 34807899WHAT IT FOUND
After pelvic abscess and fistula following pelvic exenteration, wound care without negative-pressure therapy used sitz baths, silver dressings, hypertonic saline packing, and growth-factor gel.
The fistula healed in this patient, but this does not show the dressings worked.
Key findings
01The pelvic abscess was managed by removing perineal sutures for drainage, giving potassium permanganate sitz baths, and using IV cefoperazone sulbactam after susceptibility testing.
02After a fistula developed, gauze plugging became quickly contaminated and granulation was limited, so hypertonic saline dressing was used as a plug and changed when saturated, every 2 to 3 days.
03On POD 76, a photograph showed epithelialization of the abdominal wound and fistula healing, but the patient died in June 2020.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
A single case report cannot show that any dressing, sitz bath, antibiotic, or growth-factor gel caused healing. The patient received many treatments at the same time, including drainage, potassium permanganate sitz baths, IV antibiotics, silver dressings, alginate, gauze plugging, hypertonic saline plugging, and growth-factor gel, so the contribution of any one cannot be separated. The wound course was interrupted by pelvic hemorrhage and family refusal of further therapy, and the patient died in June 2020. The patient had recurrent cancer with residual tumor, intraoperative radiotherapy, type 2 diabetes, and malnutrition, which may have affected healing independently. There was no comparison group, so it is not possible to know what would have happened without these treatments.
The easy way to misread this
Do not read the fistula healing as proof that hypertonic saline dressing works. This patient also had abscess drainage, sitz baths, antibiotics, silver dressings, alginate, growth-factor gel, and later bleeding and family refusal, so the effect of any single dressing cannot be separated.