Effect of pelvic inflammatory disease on enteric complications following radiation therapy for cervical cancer

From July, 1962, to January, 1974, 348 patients with invasive cervical cancer had evaluation, staging, and treatment with irradiation at the University of Kentucky Medical Center. Fifteen of these patients (4.5%) developed enteric obstruction or fistula six to 30 months following therapy. The presence of pelvic inflammatory disease prior to therapy was associated with a significant (p < 0.001) increase in these complications, irrespective of patient age, parity, or vascular status. Small (<100 μ in diameter) serosal vessels in the large and small bowel were studied in nonirradiated patients who died with extensive pelvic infection and in age-matched control subjects. The incidence of serosal vessel endarteritis, fibrin thrombosis, and perivascular fibrosis were significantly more common in patients with pelvic inflammation. It is suggested that the localized reactive microangiopathy associated with pelvic inflammation may play an etiologic role in the development of enteric injury following radiation therapy for cervical cancer