Gastrointestinal complications after radiotherapy for carcinoma of the uterine cervix.

Radiotherapy for invasive carcinoma of the uterine cervix caused gastrointestinal complications in 52 of 441 patients. External beam and intracavitary radiation together caused greater bowel damage than either method alone. Twenty-eight of the 52 patients required surgical intervention. Ileal stenosis in nine patients required primary resection with anastomosis in seven while the stenosis was bypassed in the other two. Acute perforation with peritonitis would require a diverting ileostomy and creation of a mucous fistula. A defunctioning colostomy was indicated for relief of pain, bleeding and stenosis of the rectum in 11 of 15 patients; 2 patients were treated by primary resection, 1 underwent abdominoperineal resection and another a pelvic exenteration. Of four patients with ileal and rectal involvement, one underwent right hemicolectomy and transverse colostomy, two had ileal resection and sigmoid colostomy and the other had hemicolectomy and rectal resection. All patients were well at follow-up from 3 to 120 months after operation. A Hartmann's procedure is indicated when it appears that primary closure may not succeed. Individualized management is essential.