Giuliani Antonio, Romanzi Federica, Di Sibio Alessandra, Calvisi Giuseppe, Lombardi Loreto, Marchese Michele, Di Staso Mario, Schietroma Mario, Carlei Francesco, Romano Lucia
Ann Ital Chir. 2019 Jun 26;8:S2239253X19030822.
Radiotherapy currently plays a key role in pelvic malignancies' management. Excellent outcomes have been reported on its association with chemotherapy for the treatment of the anal carcinoma. Despite that, the combined use of chemo- and radiotherapy and the high doses administered seem to be strongly associated with early and late onset side effects.
We reported a case of a 72 years old woman, affected by anal squamous cell carcinoma. She underwent chemotherapy, and then radiotherapy, with good results.
During a regular MR control, the patient developed anaphylactic reaction to Gadolinium, and after that a rectosigmoid ischemia with total necrosis of the posterior rectal wall was diagnosed and surgically treated with Hartmann procedure.
In our case we faced with the rapid and severe degeneration of pelvic anatomy determined by the sum of vascular alterations following hypovolemic shock and pelvic tissues alteration after radiotherapy. It seems essential not to underestimate the exponential outcome of a similar unusual combination of events.
Anal carcinoma, Hypovolemic shock, Pelvic radiotherapy, Rectal necrosis.
放射治疗目前在盆腔恶性肿瘤的治疗中起着关键作用。据报道，其与化疗联合用于治疗肛管癌取得了良好的效果。尽管如此，化疗和放疗的联合使用以及高剂量给药似乎与早期和晚期副作用密切相关。
我们报告了一例72岁女性肛管鳞状细胞癌患者。她先接受了化疗，然后接受了放疗，效果良好。
在一次常规磁共振检查期间，患者对钆发生过敏反应，之后被诊断为直肠乙状结肠缺血伴直肠后壁全层坏死，并接受了哈特曼手术治疗。
在我们的病例中，我们面临着盆腔解剖结构的迅速而严重的退变，这是由低血容量休克后的血管改变和放疗后盆腔组织改变共同导致的。似乎绝不能低估类似异常事件组合所产生的严重后果。
肛管癌；低血容量休克；盆腔放疗；直肠坏死
