Rectovaginal fistulae following radiation treatment for cervical carcinoma.

DESPITE advances in radiation technology it is still not possible to prevent serious gastrointestinal or genitourinary complications after radiotherapy. The reported incidence of gastrointestinal complications following pelvic irradiation ranges from two to 17 per cent.'23 Although rectovaginal fistulae account for less than two per cent of these complications,4 they may present a particularly difficult surgical problem from a diagnostic and therapeutic point of view. Five consecutive patients are described to illustrate some of the problems associated with their initial assessment and management. CASE REPORTS Between October 1981 and March 1982, five patients with previously treated squamous carcinoma of the cervix were admitted with rectovaginal fistulae. A brief summary of these patients is given in the Table. The external radiation was given in fractionated doses (20 exposures) over four weeks and the intra-cavity radium dose was given over a period of 60 hours in all cases. The total radiation dose ranged from 8020 to 8420 rads. Two patients (Cases 1 and 3) also had an abdominal hysterectomy and bilateral salpingo-oophorectomy, two and one month after irradiation respectively. TABLE Summary offive cases of rectovaginal fistulae