THERE are a number of patients who have been successfully treated for carcinoma of the cervix with radiation therapy in whom rectal strictures and fistulas subsequently develop. It must be kept in mind that rectovaginal fistula may be due to the actual irradiation or to the destruction of neoplasm which has already invaded rectovaginal septum. These complications occur in less than 2% of patients who have received roentgen radiation and radium therapy for cervical cancer.1 Twelve patients with these complication have been treated at the University Hospital, in Iowa City, during the past two years.
The treatment of these lesions has consisted of resection of the involved rectum and restoration of bowel continuity. The general scheme of treatment is as follows: A proximal colostomy is established, usually in transverse colon, to divert the fecal stream. The rectal segment damaged by irradiation is resected, and bowel continuity is reestablished, most