Radiation-induced small bowel diverticula: A case report of an unusual manifestation of severe radiation enteritis

Abstract

A 43-year-old woman with stage IVa cervical carcinoma was treated by pelvic radiotherapy followed by total pelvic exenteration after a vesicovaginal fistula developed. Seven weeks post exenteration, an enterocutaneous fistula occurred, necessitating laparotomy and partial ileal resection. The resected segment of ileum shewed dense adhesions, partial obstruction and dilated thinned areas forming a series of bubbles on the antimesenteric border. Microscopically, the "bubbles" were diverticula due to herniations of attenuated mucosa and sutmucosa through transversely ruptured muscularis propria. The frayed ends of the muscularis showed myocytolysis, microinfarcts and cell swelling, changes consistent with radiation damage. Following small bowel resection, new diverticula and a jejunocolic fistula were readily identified on a barium small bowel series. Massive gastrointestinal haemorrhage led to death shortly thereafter.