Eureka – objective assessment of the empty pelvis syndrome to measure volumetric changes in pelvic dead space following pelvic exenteration

Abstract

Background: large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the “the empty pelvis syndrome” (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality-of-life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS.

Methods: the true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling, the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intra-operatively using a bladder syringe, and Archimedes’ water displacement principle.

Results: a patient undergoing total infralevator PE, had a PDS of 50ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540ml, therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130ml, therefore percentage of PFV to EPD was 24.1%.

Conclusions: this is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space – these measurements may correlate to severity of EPS. PDS, EPD and PFV should be amendable to assessment based on peri-operative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.

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ORCID for Malcolm West: orcid.org/0000-0002-0345-5356

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