A Case of Radiation Enterocolitis Necrotizing Rectum Rectal Necrosis 13 Years after Radiotherapy Treated with Omental Implantation Repair

Abstract

The patient was a 53-year-old woman complaining of lower abdominal pain and watery stools. She had undergone postoperative radiotherapy for cervical cancer of the uterus about 13 years previously. Laboratory examination revealed evidences of acute inflammatory response (the WBC count of 18600/mm³, serum CRP level of 18.4mg/dl). An abdominal contrast enhanced CT scan showed that the enhancement effect was absent at the dilated sigmoid colon wall, and the rectal wall was thickened with submucosal edema. We carried out Hartmann's procedure for the necrotizing rectum and penetrating mesentery of the sigmoid colon on an emergency basis. During the surgery, we suspected that the resected stump on the anal side of rectum might be necrotizing, however, it was difficult to peel around the rectum due to severe adhesions in the pelvis. We also carried out omental implantation repair because we concerned about possible secondary perforation at the resected stump on the anal side of rectum. Pathological examination of the resected specimen showed that the rectum became necrotic, and the mesentery of the sigmoid colon was penetrated. Late reaction by radiation therapy was the most likely cause because of vascular narrowing and occlusion by hyalinized thickening, and marked fibrosis in the large intestinal wall. After the surgery, perforation of the resected stump on the anal side of rectum occurred, however, she did not go into severe peritonitis. She could escape having serious condition owing to the pelvic omental implantation repair.