In medicine (surgery), hemicorporectomy is an amputation at the waist. This removes the legs, the genitalia (internal and external), urinary system, pelvic bones, anus, and rectum. It is considered by many to be the most disabling single procedure; as with any operation, patients will have to give informed consent, and a portion will consider it incompatible with a life of happiness. It has only been reported a few dozen times in the literature[1].

The nomenclature is somewhat at odds with generally accepted anatomical terms, as hemi is generally used to refer to one of two sides (e.g. hemiplegia, which affects the arm and leg on one side of the body). In that sense, paracorporectomy might more closely reflect the nature of the procedure.

Indications

The operation most often results after spreading cancers of the spinal cord and pelvic bones. Other reasons may include trauma affecting the pelvic girdle ("open-book fracture"), uncontrollable abscess of the pelvic region (causing sepsis) or other locally uncontainable conditions.

Procedure

The surgical procedure is often done in two stages. The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit ( bladder). The second stage will be the actual amputation.

Considerations

With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored while a new blood pressure set-point develops.

Removal of large parts of the colon can lead to loss of electrolytes. Similarly, calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney, as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient.

Revalidation

Extensive physiotherapy and occupational therapy are necessary for a patient to return to some form of normal life, which invariably involves using a wheelchair. Designing a prosthesis for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly).

In emergency room context

Many emergency rooms have protocols under which they will not resuscitate or support a patient who has already undergone a severe bisection injury that is essentially a de facto hemicorporectomy. It is debatable whether this is due to anticipated quality of life, or to the poor prospects in general for someone who has lost that amount of blood and may be facing internal infections, etc.

See also

• Amputation