A Case of Perforative Peritonitis Due to Radiation Enteritis 10 Years After Radiotherapy

Abstract

Chronic radiation enteritis may occur more than 6 months after radiotherapy owing to ischemic changes of the intestine. Patients with severe radiation enteritis require surgical treatment. Because chronic radiation enteritis may develop even long after the radiotherapy for malignant disease ends, the risk of occurrence should always be considered. We report a case of peritonitis due to intestinal perforation secondary to chronic radiation enteritis 10 years after radiotherapy, and surgical management to treat the intestinal condition was required four times. The patient was a 25-year-old woman who had received chemoradiotherapy over 5 years since the age of 10 for a pelvic rhabdomyosarcoma Stage IV and achieved complete remission. She had undergone pelvic irradiation twice at a total dose of 95.4 Gy. We resected the perforation site and tried to anastomose the remaining small intestine located in a previous radiation field twice, but all such attempts failed. After the fourth operation including ileocecal resection, the residual small intestine became about 100 cm in length. Then, home parenteral nutrition (HPN) was required for 9 months. The optimal surgical method should be considered according to condition of the disease in individual patients for the treatment of chronic radiation enteritis.