SEVERE RADIATION-INJURY TO THE SIGMOID COLON

We report our experience with the surgical management of severe radiat ion injury to the rectosigmoid colon. This was a retrospective chart r eview of patients cared for by the University of South Florida gynecol ogic oncologists over a 10-year period beginning July 1, 1985. Fifteen patients were identified. Five had a sigmoid stricture. Two of these underwent transverse loop colostomy, and the other three were managed with resection and an anastomosis with protective colostomy. Four pati ents had severe sigmoiditis, three of which were complicated by hemorr hage. Three of these underwent transverse loop colostomy, and the four th underwent resection and anastomosis with protective colostomy. Thre e patients had a sigmoid fistula, with two undergoing transverse loop colostomy and the third undergoing resection and anastomosis with prot ective colostomy. There were two rectovaginal fistulas, both managed w ith transverse loop colostomy. One patient had free perforation of the sigmoid colon managed with transverse loop colostomy, and she died 4 weeks later. One patient who had been diverted for severe hemorrhagic proctosigmoiditis developed further bleeding 1 year later from the tra nsverse colon. The transverse colon and colostomy were removed, and th e remaining colon was anastomosed. All five patients who had a colorec tal anastomosis had their colostomy taken down 21/2-8 months postopera tively. One developed a rectovaginal fistula and radiation enteritis 3 months later, necessitating replacement of the colostomy and a small bowel resection. The remaining four patients have done well 7-63 month s following colostomy closure. Most cases of severe radiation injury o f the rectosigmoid colon require a diverting colostomy. Patients with severe radiation sigmoiditis, sigmoid stricture, and even fistula are sometimes candidates for eventual restoration of intestinal continuity .