Late Bladder Rupture and Strangulated Ileus Following Radical Hysterectomy and Radiation Therapy for Cervical Cancer

TL;DR

A rare case of bladder rupture leading to strangulated ileus is reported in a cervical cancer patient who had undergone radical hysterectomy and radiation therapy decades earlier.

Contribution

This is the first reported case linking bladder rupture from radiation therapy to strangulated ileus.

Findings

Bladder rupture from radiation cystitis can lead to internal hernia and strangulated ileus.

The patient presented with acute abdomen due to small intestinal incarceration at the bladder rupture site.

Histological findings confirmed late complications of radiation therapy in the bladder wall.

Abstract

Bladder rupture can occur as a late complication of radiation therapy targeting the pelvic organs. It is often diagnosed as peritonitis caused by intraperitoneal urine leakage. We report a case of an internal hernia and strangulated ileus caused by a bladder wall defect that occurred due to bladder rupture, which served as the hernia orifice.

The patient was a woman in her 70s who had undergone radical hysterectomy and postoperative radiation therapy for cervical cancer 37 years prior. She was diagnosed with a strangulated ileus and underwent emergency surgery for abdominal pain. Intraoperative findings revealed moderate amounts of clear yellow ascites and a bladder wall defect with small intestinal incarceration, leading to a strangulated ileus. The strangulated bowel was resected and the bladder wall was trimmed and sutured. A histological examination of the trimmed bladder wall revealed findings consistent with late complications of radiation cystitis.

Bladder rupture is characterized by nonspecific findings, making the diagnosis difficult. It is often diagnosed during surgery for acute abdomen. In this case, the small intestine was incarcerated at the bladder rupture site, causing strangulated ileus, a previously unreported condition. Although rare, bladder rupture should be considered a cause of strangulated ileus in the pelvic region.

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