2017 Volume 20 Issue 1 Pages 51-55
The incidence of arterial rupture following irradiation of head and neck cancer is frequently reported, but it is rare in gynecological cancer. We report a 66-year-old woman who survived rupture of the external iliac artery sixteen months after whole pelvic irradiation for recurrent ovarian cancer. She had undergone abdominal total hysterectomy and bilateral salpingo-oophorectomy for stage IA ovarian cancer, and received adjuvant chemotherapy. However, a cystic tumor recurred in the pelvis. Four regimens of chemotherapy could not effectively control the recurrent mass and she received 54 Gy of whole pelvic irradiation. Radiotherapy was effective, but sixteen months after radiotherapy, a tumor-rectal fistula formed and caused an abscess in the tumor. Thus, we performed fenestration surgery by cutting the vaginal stump under general anesthesia. Although blood loss during the surgery was low, marked genital bleeding occurred immediately after extubation and the patient went into hemorrhagic shock. Emergency angiography was performed and we observed rupture of the right external iliac artery. We therefore placed an endovascular stent graft in the ruptured artery and stopped the bleeding. Following irradiation of gynecological cancer as well as head and neck cancer, arterial rupture can occur. Computed tomography is useful to estimate its incidence. When it occurs, immediate endovascular treatment should be considered.
