Fibrosis Associated with Retroperitoneal Abscess after Multimodal Treatment of Cervical Carcinoma - A Case Report and Brief Review of the Literature

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Fibrosis Associated with Retroperitoneal Abscess after Multimodal Treatment of Cervical Carcinoma - A Case Report and Brief Review of the Literature

Alexandru Florin Săvulescu, Cristian Cîrlan, Anca Angela Simionescu, Andreea Iulia Budrugeac, Alexandra Bianca Ionescu, Dragoş Stanciu, Florin Cristian Blăjuţ
Image Quiz for surgeons, no. 3, 2021
Article DOI: 10.21614/chirurgia.116.3.361
Background: The multimodal treatment options for cervical carcinoma are represented by either radical hysterectomy associated with pelvic lymph node dissection, pelvic radiation therapy or chemotherapy. Inflammatory and post-neoplasia fibrosis associated with post-radiation fibrosis syndrome (RFS) and lymphedema may cause severe complications and quality of life alteration.

Case report: Here we present a case of a 40-year-old woman, seven months after completing standard treatment for squamous cervical cancer FIGO IIA1 with a negative impact on the quality of life due to an important abdominal and retroperitoneal fibrosis leading to significant gastrointestinal symptoms. Over a year, a symptomatic intraabdominal collection and a retroperitoneal abscess were managed in the surgery department by percutaneous drainage and exploratory laparotomy. Bowel obstruction, abscessed pelvic tumor, left colocutaneous and colocolic fistula, intra-abdominal adhesions and left uretero-hydronephrosis were found. Postoperatively, the evolution was unfavorable with upper gastrointestinal bleeding probably due to entero-mesenteric fistula followed by death.

Conclusion: Fibrosis can contribute to unfavorable clinical evolution with multiple complications and difficult management. Intra- and retroperitoneal fibrosis, neoplasia and post radiation enteropathy associated with pelvic inflammatory disease make the surgical approach difficult. Diagnosis of retroperitoneal abscess may be challenging due to nonspecific symptoms.

Keywords: fibrosis, cervical carcinoma, radiation therapy, gastrointestinal complications, radiation enteropathy, radiation fibrosis syndrome