A 35-year-old woman with a history of epilepsy undergoing treatment with ana and stage Ib2 cervical cancer underwent surgery in December 2000 and was subsequently treated with chemotherapy and brachytherapy.
In the following 3 months, at the end of the radiotherapy sessions, the patient presented intermittent low digestive bleeding, with subsequent weight-bearing, tenesmus and low abdominal pain.
The rectal examination showed an irregular mucosa and firm consistency, with an ulcerated area of approximately 2.5 cm, starting at 3 cm from the anorectal sphincter.
A clinical diagnosis of actinic colitis was made, indicating a rectoscopy which was not performed due to patient refusal.
He started treatment with enemas with prednisone, which achieved a good response.
A gynecologic examination 8 months after surgery revealed a dense, irregular area in the rectum, 8 cm from the anus, with adherence to right parametrium, which was impressive as a secondary sequel.
No imaging tests were performed, as the case was presented to the oncology committee, it was decided to perform only clinical follow-up.
The patient remained in regular outpatient follow-up, describing herself asymptomatic and with rectal stumps described as normal until her last control in May 2005.
On 02/01/2006, the patient was admitted to the emergency department for a day of diffuse colic abdominal pain, with abundant vomiting, with distended abdomen, diffusely tender.
Rectal examination revealed an indurated rectal mass (anterior), with purulent material coming out.
She was admitted to the operating room with a clinical diagnosis of diffuse peritonitis and probable intestinal perforation.
During the emergency surgery, a stenotic and indurated rectosigmoid segment was observed.
It was interpreted as a tumor, so resection of the affected segment and proximal cable arch were performed.
The patient was admitted favorably after surgery.
In pathology was received surgical piece of large intestine 9 cm long by 8 and 5 cm of perimeter at the edges of section.
At the cut, the mucosa presented a cylindrical ethenotic zone of 2 cm length to one of the edges of the section, with a dilated proximal segment presenting hemorrhagic areas and superficial fibrin deposit.
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Microscopic examination revealed marked distortion of the intestinal architecture, with fibrosis of the digestive type associated with chronic inflammatory process with hemorrhagic exacerbation in superficial granulation.
Partial absence of lamina propria was observed in one segment, with suprayacent mucous glands penetrating the muscular tunic propria, some external halves, without cytological or architectural atypias.
Blood vessels were moderately sclerotic.
In the adventitia, an area of adiponecro-sis and atherosclerotic type was found, with retraction of adjacent tissue.
No mitosis or cytological atypia were observed.
Morphological findings confirmed actinic rectus sequels.
