Delayed Disruption of Anastomosis Caused by Severe Radiation Proctitis: A Case Report

Pyong Wha Choi^1,

¹Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, Korea

Cite this paper:
Pyong Wha Choi. Delayed Disruption of Anastomosis Caused by Severe Radiation Proctitis: A Case Report. American Journal of Medical Case Reports. 2017; 5(3):50-52. doi: 10.12691/ajmcr-5-3-1

Abstract

The role of radiotherapy in the treatment of rectal cancer has been well established. However, radiotherapy-associated complications are sometimes unavoidable. Chronic radiation proctitis is a representative complication, with the incidence ranging from 5% to 20%, which in turn, can cause other severe complications such as necrosis, perforation, fistula, and stricture. Although radiation influences anastomosis wound healing, delayed anastomotic disruption caused by severe radiation proctitis is extremely rare. Here, we present a case of delayed anastomotic disruption after postoperative radiotherapy. A 66-year-old woman presented with bloody diarrhea. She had undergone low anterior resection for rectal cancer 11 months ago, and had received 28 times radiotherapy for 6 weeks with a total radiation dose of 5040 cGy, postoperatively. Sigmoidoscopy showed circumferential necrosis and gangrenous change above the previous anastomosis site on the rectum, and pelvic magnetic resonance imaging revealed disruption of the previous anastomosis site. During the operation, the affected colonic segment, including the anastomosis site, was resected and coloanal pull-through anastomosis and ileostomy were performed. This case presents an unusually severe form of late radiation injury. Although radiotherapy is necessary for the treatment of advanced rectal cancer, predicting factors for radiation injury should be clarified for personalized treatment.

Keywords:
rectal cancer radiotherapy complication radiation proctitis anastomosis

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Leiper, K. and Morris, A.I., “Treatment of radiation proctitis,” Clinical Oncology, 19 (9). 724-729. Nov.2007
[2]	Turina, M., Mulhall, A.M., Mahid, S.S., Yashar, C. and Galandiuk, S., “Frequency and surgical management of chronic complications related to pelvic radiation,” Archives of Surgery, 143 (1). 46-52. Jan.2008.
[3]	Mathias, C.A.C., Pemberton, J.H., Wolff, B.G., Dozois, R.R., Nelson, H., Young-Fadok, T.M., Devine, R.M., Nivatvongs, S., Mathison, S., Larson, D. and Ilstrup, D., “Long-term functional results of radiation after coloanal anastomosis,” Acta Cirurgica Brasileira, 14(4).
[4]	Lim S.B., Yu C.S., Kim C.W., Yoon Y.S., Park I.J. and Kim J.C., “Late anastomotic leakage after low anterior resection in rectal cancer patients: clinical characteristics and predisposing factors,” Colorectal Dis, 18(4). 135-40. Apr. 2016
[5]	Sebag-Montefiore, D., Stephens, R.J., Steele, R., Monson, J., Grieve, R., Khanna, S., Quirke, P., Couture, J., de Metz, C., Myint, A.S., Bessell, E., Griffiths, G., Thompson, L.C. and Parmar, M., “Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial,” The Lancet, 373 (9666). 811-820. Mar.2009.
[6]	Abbasakoor, F., Vaizey, C.J. and Boulos, P.B., “Improving the morbidity of anorectal injury from pelvic radiotherapy,” Colorectal Disease, 8 (1). 2-10. Jan. 2006.
[7]	Wong, M.T., Lim, J.F., Ho, K.S., Ooi, B.S., Tang, C.L. and Eu, K.W., “Radiation proctitis: a decade's experience,” Singapore Medical Journal, 51 (4). 315-319. Apr.2010.
[8]	Yeoh, E., Horowitz, M., Russo, A., Muecke, T., Robb, T., Maddox, A. and Chatterton, B., “Effect of pelvic irradiation on gastrointestinal function: a prospective longitudinal study,” The American Journal of Medicine, 95 (4). 397-406. Oct.1993.
[9]	Shadad, A.K., Sullivan, F.J., Martin, J.D. and Egan, L.J., “Gastrointestinal radiation injury: symptoms, risk factors and mechanisms.” World J Gastroenterol, 19 (2). 185-198. Jan.2013.
[10]	Bansal, N., Soni, A., Kaur, P., Chauhan, A.K. and Kaushal, V., “Exploring the Management of Radiation Proctitis in Current Clinical Practice,” Journal of Clinical and Diagnostic Research: JCDR, 10 (6). XE01-6. Jun.2016.
[11]	Gazet, M.J.C., “Parks’ coloanal pull-through anastomosis for severe, complicated radiation proctitis,” Diseases of the Colon & Rectum, 28 (2). 110-114. Feb.1985.
[12]	Lucarotti, M.E., Mountford, R.A. and Bartolo, D.C., “Surgical management of intestinal radiation injury,” Diseases of the Colon & Rectum, 34 (10). 865-869. Oct.1991.