Abstract / Summary
Abstract Introduction Radiation-induced rectal injury is a common complication of pelvic radiotherapy, but the development of rectal perforation and subsequent necrotizing fasciitis in this context is extremely rare. We report this case to alert clinicians to this potentially fatal sequela and to emphasize the importance of early recognition and aggressive intervention. Case presentation A 55-year-old Asian woman, previously treated with concurrent chemoradiotherapy for cervical squamous cell carcinoma, presented with acute abdominal pain and hematochezia 16 months after completing radiotherapy. Emergency laparotomy revealed no identifiable fistula, and a colostomy was performed. Twenty days postoperatively, necrotizing fasciitis developed in the left inguinal region. The patient underwent extensive surgical debridement. Intraoperatively, a rectovaginal fistula and a posterior rectal wall perforation were identified. The fistula was resected, the perforation was drained, and necrotic tissue was excised. After three months of wound care, the patient recovered well. At one-year follow-up, she remained in permanent colostomy status, with no recurrent pelvic abscess or residual cervical cancer. Conclusion This case illustrates that necrotizing fasciitis can be a devastating complication associated with radiation-induced rectal injury in patients with pelvic malignancies. A high index of suspicion, timely surgical debridement, and multidisciplinary management are critical for improving outcomes in this life-threatening condition. Clinicians should closely monitor post-radiation gastrointestinal symptoms to prevent the development of perforation and secondary necrotizing fasciitis.