title: Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases.
abstract: OBJECTIVE
  We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer.
  
  
  METHODS
  A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation.
  
  
  RESULTS
  The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract.
  
  
  CONCLUSIONS
  The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.
authors.affiliation: Department of Radiology, University of Tokyo Hospital, Tokyo, Japan. yamashitah-RAD@h.u-tokyo.ac.jp
authors.forename: Hideomi
authors.initials: H
authors.lastname: Yamashita
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Masao
authors.initials: M
authors.lastname: Tago
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Igaki
authors.forename: Kenshirou
authors.initials: K
authors.lastname: Shiraishi
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Nakashi
authors.initials: N
authors.lastname: Sasano
authors.forename: Sen
authors.initials: S
authors.lastname: Yamakawa
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007082:Ileum; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin