Early-onset sigmoid colon perforation during concurrent chemoradiation in a patient with cervical cancer

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

BACKGROUND

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).

CASE

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 4000 cGy in 16 fractions to whole pelvis once a day. Sigmoid colon perforation was found 40 days 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.

CONCLUSION

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.

Colonic Rupture in a Patient on Combination Chemotherapy for Metastasized Carcinoma of the Esophagogastric Junction. Case Report and Review of the Literature

BACKGROUND

Cecal perforation due to neutropenic colitis is a known and described side effect of many chemotherapy regimens. We present a case of a patient with gastric adenocarcinoma who developed spontaneous cecal perforation during chemotherapy without the classic pattern of typhlitis.

CASE REPORT

A 58-year-old woman was on chemotherapy for an adenocarcinoma of the gastric junction, when she developed a cecal perforation. There was neither evidence for leucopenia nor for typhlitis. Laparotomy was performed and cecostomy was established using the perforated bowel. Postoperative course was uneventful. The patient died from tumor progression 8 months after the diagnosis was made.

CONCLUSION

There is no evidence for a connection between this event and chemotherapy treatment but neither can it be excluded. Even if unusual, colon toxicity could be a potential life-threatening complication associated with more drugs than usually thought.