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Case Report
Ureteral stent migration through colovesical and vesicovaginal fistulas in a patient with stage IV cervical cancer treated with pelvic radiation
1 HCA Healthcare/USF Morsani College of Medicine GME (PGY-1), Department of Internal Medicine, Citrus Memorial Hospital, Inverness, Florida, USA
2 HCA Healthcare/USF Morsani College of Medicine GME (Teaching Faculty), Department of Internal Medicine, Citrus Memorial Hospital, Inverness, Florida, USA
Address correspondence to:
Jennifer Klein
Citrus Memorial Hospital, Department of Internal Medicine-Graduate Medical Education, 502 W Highland Blvd, Inverness, FL 33452,
USA
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Article ID: 100093Z10JK2021
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Klein J, Gandhi S. Ureteral stent migration through colovesical and vesicovaginal fistulas in a patient with stage IV cervical cancer treated with pelvic radiation. J Case Rep Images Oncology 2021;7:100093Z10JK2021.ABSTRACT
Introduction: Pelvic radiation is often used as radical treatment or additional therapy in patients with gynecologic malignancies. Irradiation damages deoxyribonucleic acid (DNA) of tumor cells by an inflammatory process with several inciting factors. The inflammatory process continues well after the treatment has been given and its effects can present decades after initial treatment. Complications of radiation are related to tissue damage due to parenchymal and vascular endothelial cell death as well as fibrosis resulting from innate immune response. Fibrosis is a late complication of radiation therapy and can present as stenosis or fistulas. Fistulas have an annual incidence rate of up to 5% and can develop anywhere in the irradiated field.
Case Report: This case describes a patient with vesicovaginal fistula secondary to stage IV cervical cancer treated with pelvic radiation. The patient had ureteral stent placement for radiation-induced ureteral stricture which exited the body through the anus through the vesicovaginal fistula and a colovesical fistula which developed over the course of 10 years after initial treatment with radiation therapy.
Conclusion: As cancer survivorship rates increase with improved treatments, it is important to anticipate continuing radiation damage in patients who have received radiation therapy.
Keywords: Cervical cancer, Pelvic radiation, Radiation-induced ureteral stricture, Ureteral stent, Vesicovaginal fistula
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Acknowledgments
We would like to thank Dr. Olugbenga Oyesanmi for his contribution in technical editing and proofreading.
Author ContributionsJennifer Klein - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sunil Gandhi - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Jennifer Klein et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
