Restoration of vaginal anatomy after extensive posterior wall resection utilizing human acellular dermal matrix

A 51 year old female presented with a chief complaint of hematochezia, dyschezia, tenesmus and stool incontinence. She also reported a sixmonth history of constipation and pencil thin stools. A colonoscopy demonstrated a near-circumferential friable and bulky rectal mass 4–5 cm from the anal verge (Fig. 1). Biopsy of the mass revealed a moderately differentiated adenocarcinoma presumed to be of rectal origin. Computed tomography was significant for regional lymphadenopathy without evidence of vaginal involvement. The patient's past medical history was significant for stage IB2 squamous cell carcinoma of the cervix diagnosed in her early thirties. She was treated with external beam radiation and vaginal brachytherapy, resulting in mild vaginal stenosis. In her early forties, she developed stage I breast cancer and was treated with lumpectomy with adjuvant breast radiation plus hormonal therapy. Her past medical, surgical, social and family histories were otherwise noncontributory to her current condition. On physical examination she had a patulous anus with poor resting anal tone and an easily palpable rectal mass approximately 4 cm from the anus involving about 75% of the luminal circumference. Staging