Sigmoid colon perforation after postoperative hypofractionated intensity-modulated radiation therapy in a cervical cancer patient.

Abstract

Radiation-induced complication occurs in two phases: acute and chronic toxicities. Bowel perforation is regarded as a chronic toxicity associated with injury to vascular and connective tissue. It is usually noted a few months to several years after radiation treatment (RT). Herein, we present a case of sigmoid colon perforation relatively early after completion of RT. A 70-year-old woman was treated with laparoscopic radical hysterectomy and postoperative hypofractionated intensity-modulated RT for clinical stage IB1 cervical cancer. RT was delivered with a total dose 4000cGy in 16 fractions to whole pelvis once a day. Sigmoid colon perforation was found 40days after completion of RT without any typical signs of perforated viscera. Emergency exploratory laparotomy was performed. Pathology revealed chronic inflammation with mucosal ulceration and submucosal fibrosis, a typical radiation effect. Although the cause of perforation remains unclear, early-onset sigmoid colon perforation as an effect of irradiation can occur. We should keep in mind the possibility of perforation in the care of radiated patients who present abdominal pain with atypical presentation regardless of satisfaction of dose constraint for radiotherapy.