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Radiation-associated ischemic coloproctitis: report of two cases
H Tomori1, T Yasuda, M Shiraishi
1Department of Surgery I, Clinical Laboratory Medicine, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan.
Surgery Today
|December 10, 1999
Summary
Radiation-induced ischemic coloproctitis, a rare complication of pelvic radiotherapy, can lead to rectosigmoid colon perforation. This study details two cases, highlighting varied necrosis patterns and successful surgical management.
Area of Science:
- Gastroenterology
- Oncology
- Surgical Pathology
Background:
- Radiation-associated ischemic coloproctitis is a rare but serious complication following pelvic radiotherapy, particularly for gynecological cancers.
- It arises from vascular insufficiency affecting the rectosigmoid colon, potentially leading to transmural necrosis and perforation.
Observation:
- This report presents two distinct cases of radiation-associated coloproctitis with transmural necrosis and subsequent perforation.
- Case 1: A 46-year-old woman developed perforation 3.5 years post-radiotherapy due to intramural vascular obliteration from fibrosis.
- Case 2: A 55-year-old woman experienced perforation 1.5 years post-radiotherapy, caused by mesenteric artery thrombosis.
Findings:
- Both patients presented with transmural necrosis of the rectosigmoid colon.
- Histopathological analysis revealed different underlying vascular pathologies: intramural vascular obliteration versus mesenteric artery occlusion.
- Both patients underwent successful Hartmann's resection and survived the perforative event.
Implications:
- These cases underscore the delayed and potentially severe gastrointestinal complications of pelvic radiotherapy.
- Understanding the varied mechanisms of vascular compromise is crucial for timely diagnosis and management.
- Surgical intervention, such as Hartmann's resection, can be effective in managing radiation-induced colonic perforation.