Multidisciplinary Surgical Management of Radiation-Induced Colorectal Stricture and Pelvic Adhesions: A Case Report

Radiation-induced colorectal strictures represent a challenging late complication of pelvic malignancy treatment, often accompanied by extensive fibrosis and multi-organ involvement. We report the case of a 55-year-old female with a history of cervical cancer treated with pelvic radiation, complicated by radiation proctitis, diverticular disease, pelvic adhesions, and bilateral ureteral obstruction, who underwent a single-stage multidisciplinary surgical reconstruction. The procedure included colostomy takedown, rectosigmoid resection with coloanal anastomosis, pelvic abscess debridement, diverting loop ileostomy creation, total abdominal hysterectomy, ileoureteral conduit formation, and ventral hernia repair with myocutaneous flap closure. The postoperative course was complicated by a high-output ileostomy resulting in electrolyte derangements, acute kidney injury, and malnutrition, requiring coordinated medical management with antidiarrheal therapy, electrolyte repletion, and nutritional support. This case underscores the complexity of late radiation sequelae and highlights the importance of multidisciplinary collaboration in achieving successful surgical and medical outcomes.