Radiation Rectovaginal Fistula

Abstract

In 1974, the patient, aged 28 years, was diagnosed with chorionic carcinoma. Local spread had formed a large pelvic mass and lung metastases were present. The latter disappeared after treatment with methotrexate. Laparotomy was performed in August 1974 when extensive pelvic spread was found beyond surgical excision. This pelvic disease was successfully treated with external beam radiotherapy (58.6 Gy) and actinomycin D. Eighteen months after completing this treatment, the patient was referred for the surgical management of a stricture (6 mm in diameter) of the rectum and a rectovaginal fistula discharging into the posterior fornix. Investigations revealed no evidence of recurrent tumor. The skin of the perineum showed evidence of tissue reaction to radiotherapy (Figure 100.1).