IT’S COMPLICATED: A CASE REPORT ON RUPTURED VISCUS AFTER PELVIC IRRADIATION perez.laramichelle@yaho.com

 

IT’S COMPLICATED: A CASE REPORT ON RUPTURED VISCUS AFTER PELVIC IRRADIATION

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Philippines

Poster Exhibition only

Radiotherapy to the pelvic area could cause major complications including radiation enterocolitis, occurring 8% to 13% when done alone and up to 21% when multi-modal. We described the patient managed as Intraductal carcinoma St IV (Bone) who underwent adjuvant chemotherapy and palliative radiotherapy with radiation-associated colon complication.

Patient was a 61 year-old-female being managed as a case of Intraductal carcinoma St IV (Bone T11-L5, S1-S2) s/p Modified radical mastectomy, right s/p adjuvant chemotherapy and palliative radiotherapy (bone) x 10 sessions. 2 weeks after the last session of radiotherapy, patient presented with generalized abdominal pain with direct tenderness on right lower quadrant and hypogastric area. For consideration of appendicitis, a whole abdomen CT scan was done showing pneumoperitoneum but with no gross focal lesion. We decided on an emergency laparotomy expecting appendicitis or sigmoid diverticulitis. It however revealed a 2 cm defect on the midsigmoid with abscess and adhesions. Surgeons proceeded to sigmoidectomy with end colostomy.

Patient tolerated the procedure well. Diet resumed and aggressively progressed. Histopathology report showed acute suppurative inflammation with granulation tissue and peritonitis.

Pelvic radiation can cause late effects like weakening the colon wall, leading to perforation. In these patients, ruptured viscus may not present with the classic signs of peritonitis, especially when confined by adhesions, which is another complication. The symptoms can be subtle or atypical, making diagnosis challenging. However, due to its incidence and risk of morbid complications, a high degree of suspicion remains a priority in care.