Successful Restoration of Fecal Continence Using Sacral Nerve Stimulation Following Chemoradiation and Transanal Excision of an Anal Melanoma With Partial Internal Anal Sphincter Resection: A Case Report

Neuromodulation. 2017 Dec;20(8):783-786. doi: 10.1111/ner.12562. Epub 2017 Feb 1.

Abstract

Objective: This case report provides evidence for our hypothesis that use of a sacral nerve stimulator may be considered in patients with fecal incontinence (FI) following chemoradiation and transanal operations in the setting of cancer including partial internal sphincter resections.

Materials and methods: A 57-year-old female with a history of anal melanoma was treated with neoadjuvant chemoradiation followed by wide local, transanal tumor excision with partial internal anal sphincter resection that resulted in ≥2 full fecal incontinent episodes/week with gas, liquid, and solid stool leakage ≥10/day requiring pad changes. After seven years of progressive FI, a sacral nerve stimulator was implanted following pre-placement anorectal manometry. Pre and post implant validated Cleveland Cleveland Clinic/Wexner Fecal Incontinence questionnaires and daily stool diaries (Medtronic) were completed. Data was stored in and collected from the patient's electronic health record.

Results: The patient had a single episode of FI during the two week trial phase, but reports complete resolution of FI, urgency, and leakage since implantation through her 1-year post-implant follow-up visit. Additional improvements were noted in FI questionnaires: Cleveland Clinic/Wexner Fecal Incontinence Score of 17 at baseline to 3 post-implant and Fecal Incontinence Quality of Life Score of 3.585 at baseline to 3.93 post-implant.

Conclusions: The application of sacral nerve stimulation may not be as limited as previously thought and should be considered for cancer survivors following chemoradiation and sphincter-sparing rectal and transanal resections. Though this single case report is suggestive, further research is necessary and would include a research protocol designed specifically for patients who have undergone chemoradiation and/or sphincter-sparing operations. We are currently working on such protocol at our institution.

Keywords: Fecal incontinence; internal anal sphincterectomy; sacral nerve stimulation.

Publication types

  • Case Reports

MeSH terms

  • Anal Canal / diagnostic imaging
  • Anal Canal / surgery*
  • Chemoradiotherapy* / methods
  • Electric Stimulation Therapy / methods*
  • Fecal Incontinence / diagnostic imaging
  • Fecal Incontinence / etiology
  • Fecal Incontinence / therapy*
  • Female
  • Humans
  • Lumbosacral Plexus* / diagnostic imaging
  • Melanoma / complications
  • Melanoma / diagnostic imaging
  • Melanoma / therapy*
  • Middle Aged
  • Sacrum / diagnostic imaging
  • Sacrum / innervation
  • Treatment Outcome