Rectal injury during permanent seed implantation for prostate brachytherapy

• Published in: Japanese journal of clinical oncology Vol. 42; no. 12; pp. 1207 - 1210
• Main Authors: Ishida, Masaru, Sugawara, Akitomo, Matsushima, Masashi, Ohara, Rei, Katayama, Michiaki, Nakajima, Yosuke
• Format: Journal Article
• Language: English
• Published: England 01-12-2012
• Subjects: Aged; Brachytherapy - adverse effects; Humans; Ileostomy; Intestinal Perforation - diagnostic imaging; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Male; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - radiotherapy; Rectum - injuries; Tomography, X-Ray Computed; Ultrasonography, Interventional - adverse effects
• ISSN: 0368-2811; 1465-3621
• DOI: 10.1093/jjco/hys165

Serious complications have not been previously reported during seed implantation for prostate brachytherapy. We present an unreported case of rectal injury caused by an ultrasound probe. A 67-year-old male presented with a serum prostate-specific antigen level of 5.50 ng/ml, a Gleason score of 7 (3 + 4) and clinical T2a adenocarcinoma of the prostate. A transperineal permanent prostate brachytherapy implantation was performed. The patient subsequently complained of abdominal pain postoperatively. A gastrointestinal perforation was suspected based on an abdominal X-ray obtained on the day after the brachytherapy. Rectal injury was recognized during an exploratory laparotomy, and a primary closure and temporary diversion ileostomy were performed. The healing of the injury was confirmed by colonoscopy and an ileostomy closure was performed 2 months after the temporary diversion. The investigating committee for this accident concluded that the ultrasound probe had perforated the rectum. This is the first case of a rectal injury during seed implantation for prostate brachytherapy.