Small bowel perforation after radiotherapy for cervical carcinoma

Abstract

Radiotherapy is one of the treatment modalities for carcinoma of the abdominopelvic organs. Radiation enteritis is a rare complication of abdominopelvic radiotherapy at the present time. Chronic radiation enteritis with complications, e.g. stricture, perforation and fistula formation, causes significant morbidity and mortality. We present a 32-year-old woman with cervical carcinoma, in whom small bowel (ileum) perforation developed 4 months after radiotherapy. Severe abdominal pain and signs of peritonitis were seen. Surgery was performed immediately. Two perforation sites were seen, ten centimetres and five centimetres of small bowel, including the perforation sites, were resected and anastomosed. No bowel adhesion was detected during the operation but bowel wall was very fragile. The postoperative course was uneventful, and the patient was discharged home 7 days after surgery. Histological examination confirmed post-irradiation injury. The complaints of patients with bowel perforation following radiotherapy varied, and signs of peritonitis may be lacking. Emergency Unit staff must be alert for small bowel perforations in patients who have been treated with radiotherapy.