The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report
Abstract Background Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-024-04516-0 |
| _version_ | 1797209385458466816 |
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| author | Wujian Lin Bing Yao Jiahui He Shuangyan Lin Yafei Wang Fangting Chen Weichao Zhang Jiashu Yang Zhihong Ye Jianguang Qiu Yuling Wang |
| author_facet | Wujian Lin Bing Yao Jiahui He Shuangyan Lin Yafei Wang Fangting Chen Weichao Zhang Jiashu Yang Zhihong Ye Jianguang Qiu Yuling Wang |
| author_sort | Wujian Lin |
| collection | DOAJ |
| description | Abstract Background Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. Case presentation A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. Conclusion Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration. |
| first_indexed | 2024-04-24T09:53:52Z |
| format | Article |
| id | doaj.art-ff09a2a02a6e458dae91bed9c1f84007 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-24T09:53:52Z |
| publishDate | 2024-04-01 |
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| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-ff09a2a02a6e458dae91bed9c1f840072024-04-14T11:17:30ZengBMCJournal of Medical Case Reports1752-19472024-04-011811910.1186/s13256-024-04516-0The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case reportWujian Lin0Bing Yao1Jiahui He2Shuangyan Lin3Yafei Wang4Fangting Chen5Weichao Zhang6Jiashu Yang7Zhihong Ye8Jianguang Qiu9Yuling Wang10Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Urology, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityDepartment of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-Sen UniversityAbstract Background Total pelvic exenteration is the ultimate solution for rectovesicovaginal fistula caused by radiation therapy, yet total pelvic exenteration frequently causes intraoperative complications and postoperative complications. These complications are responsible for the dysfunction of lower extremities, impaired quality of life, and even the high long-term morbidity rate, thus multidisciplinary cooperation and early intervention for prevention of complications are necessary. Physical therapy was found to reduce the postoperative complications and promote rehabilitation, yet the effect on how physiotherapy prevents and treats complications after total pelvic exenteration and pelvic lymphadenectomy remains unclear. Case presentation A 50-year-old Chinese woman gradually developed perianal and pelvic floor pain and discomfort, right lower limb numbness, and involuntary vaginal discharge owing to recurrence and metastasis of cervical cancer more than half a year ago. Diagnosed as rectovesicovaginal fistula caused by radiation, she received total pelvic exenteration and subsequently developed severe lower limb edema, swelling pain, obturator nerve injury, and motor dysfunction. The patient was referred to a physiotherapist who performed rehabilitation evaluation and found edema in both lower extremities, right inguinal region pain (numeric pain rate scale 5/10), decreased temperature sensation and light touch in the medial thigh of the right lower limb, decreased right hip adductor muscle strength (manual muscle test 1/5) and right hip flexor muscle strength (manual muscle test 1/5), inability actively to adduct and flex the right hip with knee extension, low de Morton mobility Index score (0/100), and low Modified Barthel Index score (35/100). Routine physiotherapy was performed in 2 weeks, including therapeutic exercises, mechanical stimulation and electrical stimulation as well as manual therapy. The outcomes showed that physiotherapy significantly reduced lower limb pain and swelling, and improved hip range of motion, motor function, and activities of daily living, but still did not prevent thrombosis. Conclusion Standardized physical therapy demonstrates the effect on postoperative complications after total pelvic exenteration and pelvic lymphadenectomy. This supports the necessity of multidisciplinary cooperation and early physiotherapy intervention. Further research is needed to determine the causes of thrombosis after standardized intervention, and more randomized controlled trials are needed to investigate the efficacy of physical therapy after total pelvic exenteration.https://doi.org/10.1186/s13256-024-04516-0PhysiotherapyCervical cancerTotal pelvic exenterationPostoperative complicationsCase report |
| spellingShingle | Wujian Lin Bing Yao Jiahui He Shuangyan Lin Yafei Wang Fangting Chen Weichao Zhang Jiashu Yang Zhihong Ye Jianguang Qiu Yuling Wang The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report Journal of Medical Case Reports Physiotherapy Cervical cancer Total pelvic exenteration Postoperative complications Case report |
| title | The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report |
| title_full | The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report |
| title_fullStr | The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report |
| title_full_unstemmed | The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report |
| title_short | The effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy: a case report |
| title_sort | effect of physical therapy and mechanical stimulation on dysfunction of lower extremities after total pelvic exenteration in cervical carcinoma patient with rectovesicovaginal fistula induced by radiotherapy a case report |
| topic | Physiotherapy Cervical cancer Total pelvic exenteration Postoperative complications Case report |
| url | https://doi.org/10.1186/s13256-024-04516-0 |
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