Fibrosis Associated with Retroperitoneal Abscess after Multimodal Treatment of Cervical Carcinoma - A Case Report and Brief Review of the Literature

Background: The multimodal treatment options for cervical carcinoma are represented by either radical hysterectomy associated with pelvic lymph node dissection, pelvic radiation therapy or chemotherapy. Inflammatory and post-neoplasia fibrosis associated with post-radiation fibrosis syndrome (RFS) and lymphedema may cause severe complications and quality of life alteration. Case report: Here we present a case of a 40-year-old woman, seven months after completing standard treatment for squamous cervical cancer FIGO IIA1 with a negative impact on the quality of life due to an important abdominal and retroperitoneal fibrosis leading to significant gastrointestinal symptoms. Over a year, a symptomatic intraabdominal collection and a retroperitoneal abscess were managed in the surgery department by percutaneous drainage and exploratory laparotomy. Bowel obstruction, abscessed pelvic tumor, left colocutaneous and colocolic fistula, intra-abdominal adhesions and left uretero-hydronephrosis were found. Postoperatively, the evolution was unfavorable with upper gastrointestinal bleeding probably due to entero-mesenteric fistula followed by death. Conclusion: Fibrosis can contribute to unfavorable clinical evolution with multiple complications and difficult management. Intra- and retroperitoneal fibrosis, neoplasia and post radiation enteropathy associated with pelvic inflammatory disease make the surgical approach difficult. Diagnosis of retroperitoneal abscess may be challenging due to nonspecific symptoms.