CASE 35: Cervical cancer metastasizing to the left sacroiliac joint

• 42-year-old woman
• She underwent surgery and received medical treatment due to cervical cancer.
• She received radiotherapy for left sacroiliac metastasis but did not achieve satisfactory results.
• The patient arrived in a wheelchair because they could not walk and even had difficulty sitting.
• During the surgery, it was found that the main vessels supplying the left leg (external iliac artery and vein) were blocked, and the intestine (sigmoid colon) and urinary tract (ureter) were invaded by the tumor, along with a dense infection tissue.
• After the tumor was removed in one piece along with the adjacent bone and soft tissues (sacroiliac resection), the ureter and sigmoid colon were brought out through the anterior abdominal wall (colostomy). Then, the occluded portion of the external iliac artery and vein was removed, and blood flow was restored with a synthetic graft. Due to severe infection, bone reconstruction was not performed on the patient, who underwent debridement and lavage.

Preoperative: X-ray shows no significant abnormalities in the left ureter except for a catheter, while MRI reveals a large soft tissue mass at the level of the left sacroiliac joint with irregular borders, a gas shadow, and displacing the bladder.

During surgery: Tumor invasion of the sigmoid colon, ureter, and iliac wing.

During the operation: Resection of the external iliac artery and vein along with the tumor, and bypass surgery with a synthetic graft.

Surgical procedure: Bone incisions are made and the tumor tissue is viewed via fluoroscopic imaging.

Postoperative: X-ray shows sacroiliac resection.