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Rectovaginal fistulas (RVF) represent less than 5% of anorectal fistulas. The classification of RVF is based on the localization (low vs. high) and the etiology. The most frequent causes of RVF are birth trauma, Crohn's disease, previous surgery and pelvic irradiation. In most cases a clinical diagnostic assessment is sufficient. Additionally, endosonography is a reliable tool to detect sphincter defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are reserved for special situations (e.g., RVF related to anastomotic leakage, after pelvic irradiation or associated with complex perianal fistulizing Crohn's disease). The surgical treatment is primarily oriented to the localization and etiology. Surgical techniques range from local procedures (e.g., endorectal advancement flap repair, transvaginal or transperineal closure) up to more invasive tissue interposition (e.g., bulbocavernosus muscle fat tissue flap or transposition of the gracilis muscle). In "high" RVF transabdominal approaches such as coloanal anastomosis, pull through procedures or omental interposition are indicated. All surgical procedures show high recurrence rates. Several operations are mostly necessary and a stoma creation is often required., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: Gemäß den Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben. Autoren: O. Schwandner: A. Finanzielle Interessen: Takeda, Medtronic, AbbVie, Falk Foundation, med update (Honorar für Referententätigkeit, Reise- und Übernachtungskosten). – B. Nichtfinanzielle Interessen: Berufliche Tätigkeit: Leitender Arzt der Abteilung für Proktologie, Krankenhaus Barmherzige Brüder Regensburg | Mitgliedschaften in wissenschaftlichen Gesellschaften: Deutsche Gesellschaft für Chirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Deutsche Gesellschaft für Koloproktologie, Vereinigung der Bayerischen Chirurgen, Deutsche Kontinenz Gesellschaft, American Society of Colon & Rectal Surgeons | Mitgliedschaft in Berufsverbänden: Berufsverband der Deutschen Coloproktologen | Position in wissenschaftlicher Fachgesellschaft: Mitglied des Vorstands der Deutschen Gesellschaft für Koloproktologie (Generalsekretär). Wissenschaftliche Leitung: Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme . Der Verlag: erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The rectovaginal fistula is a rare entity with heterogenic causality. Its genesis seems to predict the extent of operative treatment and the prognostic outcome. The aim of this study was to present different surgical techniques in the treatment of rectovaginal fistulas and their results in correspondence to the genesis., Material and Methods: Between 1 / 2000 and 1 / 2010, the data of patients with rectovaginal fistulas were collected. The retrospective analysis included biographic and anamnestic data as well as clinical parameters, general and specific complications and postoperative data., Results: In a timespan of ten years 36 patients with rectovaginal fistulas were treated. The most common causes were inflammatory diseases (n = 21) and earlier surgical measures (n = 6). Moreover tumour-associated fistulas (n = 5) and fistulas with unknown genesis (n = 4) were seen. As surgical techniques anterior resection (n = 21), transrectal flap plasty (n = 7), subtotal colectomy (n = 3), pelvine exenteration (n = 2) and rectal exstirpation (n = 1) were used. The closure of the vaginal lesion was performed by single suture (n = 25), flap plasty (n = 6), transvaginal omental plasty (n = 2) and posterior vaginal plasty (n = 1). All patients were provided with an omental plasty to perform a safe division of the concerned regions. Patients with a low fistula ( < 6 cm) were treated with transperineal omental plasty. The median follow-up was 12 months (6 - 36). Within this timespan 6 patients suffered from major complications [ARDS, anastomosis insufficiency, postoperative bleeding, recurrence of fistula (n = 3)]. Three patients died in the postoperative period (cerebellar infarct, septic complication associated with Crohn's disease, multiorgan failure in tumour recurrence)., Conclusion: The genesis of rectovaginal fistulae is an important predictor for the size of resection which can range from simple excision to exenteration. For optimal therapy the surgical intervention needs to be integrated into an interdisciplinary therapy concept., (© Georg Thieme Verlag KG Stuttgart · New York.)

Rectovaginal fistuale (RVF) are a serious and disabling problem for the patients and a surgical challenge for the treating physicians. The most common causes of RVF are postoperative complications, inflammatory bowel disease, complications of radiotherapy, obstetric complications, and neoplasia. Therapeutic options are diverse and results often unsatisfactory. This article presents the treatment of patients with rectovaginal fistulae in the general surgery department of University Hospital in Duesseldorf, Germany. The therapeutic strategy for treatment of RVF is divided according to aetiology, localisation, and comorbidity. A diverting ileostomy is particularly useful if acute inflammation exists. Secondary repair may then be a better option. An initial approach with a local repair by preanal repair is justified in low RVF. For failures muscle flaps are promising., (Georg Thieme Verlag Stuttgart ˙ New York.)

Longo's STARR operation is a new surgical technique for the management of obstructive defecation syndrome. A major advantage is the repair of rectocele and intussusception in a single transanal approach. Complications such as bleeding, infection, anal stenosis, and fistulas are known. In the described patient we detected a cavity in the spatium rectovaginale which was lined by rectum mucosa and connected to the rectum as a result of an incomplete resection of rectum wall and dilatation of the stapler suture. Recurrent stool incrustration in the cavity led to preformation of coproliths. We performed a modified Rehn-Delorme operation to resect the cavity. The STARR operation is a technique which should be used carefully and performed only by surgeons with experience and full knowledge of the potential complications.

Introduction: Sphincterotomy can be avoided in the repair of high anorectal or rectovaginal fistulas by use of rectal advancement flaps., Methods: Between 1986 and 1998, 22 patients with high anorectal and 15 patients with rectovaginal fistulas underwent fistulectomy without sphincterotomy and consecutive transanal rectal advancement flap repair., Results: Primary healing was achieved in 81% (30/37 patients). There was no disturbance of continence though anal resting pressures decreased postoperatively. Recurrences occurred in 4 of 12 patients with Crohn's disease (2 anorectal, 2 rectovaginal) and in 1 patient with traumatic anorectal fistula. There were no recurrences in patients with cryptoglandular disease, while the operation failed in 2 patients with ergotamine-induced fistulas., Conclusions: This operative approach achieves a high primary healing rate with optimal functional outcome. Despite good results the indication should be set carefully in patients with Crohn's disease.

Rectovaginal fistulae following low anterior resection are rare, but if present therapy is difficult. We report on a 52-year-old patient who was operated upon several times, including an endorectal advancement flap procedure and transperineal repair with levator interposition. Closure was only successful after transposition of the M. gracilis between the vagina and rectum.

Rectovaginal fistulas, persistent sinus following proctectomy, urethro-rectal fistulas after radical prostatovesiculectomy can be closed using a pedicular muscle flap from m. glutaeus maximus. 7 procedures, using this technique and the results are described in detail.

Unlabelled: A prospective study was carried out on 88 patients with rectovaginal fistulae to evaluate the value of two sphincter-saving techniques: primary occlusion of the intraanal ostium and endorectal advancement flap (n = 37) or transperineal repair with levator interposition (n = 34). Causes were Crohn's disease 35, obstetric injury 31, proctological-gynecological operation 11, cryptoglandular 11. Perineal group: 11 patients underwent concomitant anterior sphincter plication. Crohn group (n = 35): endorectal advancement flap was performed in 8 patients only, and 10 with intra- or supraanal stenosis were treated by transperineal approach, 12 (34%) with extended perianal fistula complaints required primary proctectomy, and operative therapy was not possible in 5 with persistent rectal inflammation. No deaths occurred. Postoperatively 12 cases (17%) of suture leakage occurred (flap group (FG): 16.2%, transperineal group (TPG): 17.6%). Persistent or recurrent fistula occurred in 8 patients (11%), 5.4% FG, 17.6% TPG. Disturbance of continence was observed in one patient after endorectal approach. Postoperatively there were no significant changes in the resting anal pressure and maximum voluntary contraction pressure. A complete primary healing with no further recurrence (follow-up 3 months to 9.5 years) was noted in 78.4% FG and 64.7% TPG. One patient with postoperative incontinence after the endorectal flap, had undergone anterior levator plication with perineal body reconstruction., Conclusions: Endorectal advancement flap allows preservation of the sphincter and is an effective method for repair of rectovaginal fistulae. The endorectal advancement flap proved to result in a better primary healing rate with 85% than the mucosal advancement flap with 65%. Perineal procedures are indicated in selected patients with simultaneous sphincter plication and in Crohn's fistulae associated to intra- or supraanal stenosis.

The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.

Since 1975 a total of 55 patients with vesicovaginal fistulas have undergone surgery at the Clinic of Urology, University of Saarland, Homburg/Saar. A majority (55%) of the cases were complicated. In 9 cases supravesical urinary diversion was necessary. Successful closure of the fistula was achieved in 45 patients (81.8%); only in one case is the fistula still present. In 5 patients with uncomplicated fistulas successful closure was accomplished by a vaginal approach. In the presence of complications, e.g., previous radiotherapy or accompanying lesions of the ureter or rectum, a transvesical/transabdominal approach was preferred; surgery was successful in 93.3% of such cases.

This is a report on 14 enterovaginal fistulae following gynecologic operations. The fistulae were caused by a hysterectomy in 8 cases. There were 3 other enterovaginal fistulae following exploratory laparotomy for ovarian tumors, which proved to be pseudotumors caused by diverticulitis of the sigmoid colon. Rare causes for fistulae were cesarian section, episiotomy, and incision of an abscess of Bartholins' gland. The time interval between operation and manifestation of the fistula was usually about 10 days. The operative management required a two-or three-step procedure. Only 2 of 14 patients were treated by a colostomy, and a bowel resection was performed in 4 cases. After dissection of the fistula either peritoneum or omentum was interposed in 8 patients. No recurrences were observed.

The analysis of 770 patients after irradiation of cervix-carcinoma from 1968 to 1976 with Cobalt 60, radium or operation or only irradiation therapy shows five-year survival rates of 78% for stage I, 61% for stage II, and 23% for stage III. Bowel reaction was seen in 27%, 4% developed stenoses, 1.3% a recto-vaginal fistula. A complication of the bladder was seen in 18%, 2.7% had an ureteral stricture and 0.8% a bladder-fistula.

Total parenteral nutrition was given to 10 patients with acute regional enteritis for 3--12 weeks. The rationale of this therapy is elimination of potential food allergens and decrease of intestinal irritation. Complete remission of the disease could be achieved in 8 patients, thus surgical removal of the intestine involved could be avoided. One entero-cutaneous and two perinal fistulas healed spontaneously; two other perianal fistulas improved so much, that local surgical treatment was sufficient. If well planned, total parenteral nutrition can be performed without disturbance of metabolism and septicemia caused by the catheter can be avoided. No final judgement about recurrence of regional enteritis after total parenteral nutrition is possible at present due to as yet limited experience.

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated at the Radiotherapy Department of the I. University Clinic for Gynecology and Obstetrics in Vienna. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: primarily a focal irradiation of the tumor by plaque-application, then combined intra-uterine and intra-vaginal radium insertion, followed by a vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily , if the tumor was localised in the lower third of the vagina. 5-year overall remission rate amounted to 32% for the years 1971 to 1977; hence it was somewhat lower than for the total time observed (1950 to 1977), which was 39,8%. This could be explained by the sharp increase of very old patients and of progressed stages. For separate stages, the following 5-year healing rates were observed: stage I: 78%; stage II: 48%; stage III: 24% and stage IV: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Only 1 patient of 15 (7%), who were not treated by teletherapy, reached 5-year remission , as compared to 14 of 52 (27%), who received teletherapy. Stages I and II did not show a comparable difference. Intrauterine brachytherapy was of more importance for remission rate in early stages: 11 of 16 (69%) patients with stages I and II, who were treated with intrauterine curietherapy, survived 5 years or more; of those who did not have intrauterine insertion, only 6 of 15 (40%) reached 5-year remission . For stages III and IV, intrauterine curietherapy did not markedly change the healing rate.

A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinomas. Intravaginal brachytherapy (Ra226, vaginal cylinder applicator) is given. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). Reversible complications (cystitis, proctitis) could be observed in 7%, irreversible complications (fistulas, stenosis) in 1.9% of the cases, respectively. The rate of radiation side effects after primary operation is lower than after primary irradiation of endometrial carcinoma. This is contrary to the results in postoperative irradiation of cervical carcinoma with a markedly higher rate of irradiation side effects. After postoperative intravaginal brachytherapy (Ra226) alone, only in 5.9% of the cases reversible and in 0.8% irreversible complications were observed.

Report on 2309 vaginal hysterectomies. The leading indication for vaginal hysterectomy was benign disease of the uterus (54.4%). Utero-vaginal prolapse was the indication in approximately 32% of the patients. In 71.1% of the hysterectomies, the vaginal approach for removal of the uterus was selected in malignant and pre-malignant diseases. Of these cases 11.9% had carcinoma in situ and 2.7% had micro-invasive carcinoma of the cervix. 2.6% of these cases had carcinoma of the endometrium. In 69.9% of the cases the vaginal hysterectomy was combined with a colporrhaphy. Previous genital operations or laparotomies where no contra-indication to vaginal hysterectomy. Trauma to the urinary tract or the rectum occurred in 26 cases (1.02%). Post-operatively 3 urinary tract fistulas and 3 rectovaginal fistulas developed. The mortality was 0.51%. Among 272 cases of carcinoma in situ and 62 cases of micro-invasive carcinoma of the cervix treated by vaginal hysterectomy, one case developed a recurrent carcinoma in situ of the vaginal vault eight years after vaginal hysterectomy for carcinoma in situ. One patient treated for micro-invasive carcinoma of the cervix died four years following vaginal hysterectomy in another hospital of suspected pulmonary metastases. The diagnosis was not confirmed by autopsy. Simple total hysterectomy whenever possible by the vaginal approach is at present the maximal treatment in the University Department in Graz for carcinoma in situ and micro-invasive carcinoma of the uterine cervix.

Between 1962 and 1980, 237 patients with carcinomas of the cervix have been treated at the Radiologic Hospital of the University of Münster. With respect to the year of the treatment, six groups were formed depending on the observation period which was one year, two years, three years, four years, five years or more than five years. 68 women (29%) out of these groups had vesical reactions and 116 (49%) intestinal reactions. Most of the bladder reactions were early reactions appearing during the first three months, and the rate of vesical and intestinal troubles was higher after combined therapy with operation and irradiation than after primary radiotherapy. The therapy effects to bladder and intestine were classified by a method proposed by Holstein and Hess according to which even insignificant troubles are taken into consideration. 15 patients had stases concerning the ureters or kidneys. In five cases a rectovaginal fistula and in four cases a vesicovaginal fistula was demonstrated as a therapy effect. Furthermore, the following reactions were observed: radiation sickness, cutaneous reactions, marked vaginal fluor, heavy lumbago, general abdominal troubles, vaginal bleedings, fever after the insertion of radium as well as thrombosis and embolism.

At first the general problems of operations in the x-ray treated tissue are discussed. After that 11 cases of patients, who were x-rayed, were demonstrated. With these patients we carried out a radical operation, because the cancer of cervicis was insufficiently affected by a primary radiological therapy. The bad turn of disease could not be stopped at 6 cases. The women patients got either uretero-vaginal-fistulae (2) or recto-vaginal-fistulae (2) or combined vesico-recto-vaginal-fistulae (1) and in less than one year they died of recidiv of cancer. Two women patients are still tended on account of their vesico-recto-vaginal fistulae. Only three women had been cured satisfactorily and they are till now free of recidivs for 4 to 7 years.

In a retrospective study the incidence was determined of reversible and irreversible complications in 176 cases of cervical cancer stages I and II treated by operation and postoperative irradiation, in 329 cases of cervical cancer stages III and IV treated by irradiation alone. Severe, irreversible complications (fistulae) occurred in a significantly higher percentage of patients in the group given combined treatment (7.4%) compared with the group treated by irradiations alone (0.6%); p=0.01). The incidence of fistulae was even twice as high in the group of operated and irradiated patients with cervical cancer stages I and II than in the group of patients with cervical cancer stages III and IV treated by irradiation alone (3.2%). Hence, postoperative radiotherapy appears to be rather dangerous. Since primary irradiation achieves the same 5-year survival rate, but is connected with significantly fewer complications, it is pointed out that those cases of cervical cancer which seem to be technically operable, but will probably have to undergo postoperative irradiation, should better be treated by irradiation alone.

362 cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynaecology, Vienna, from 1950 to 1977. As method of choice an individually dosed, fractioned and protracted radium-telecobalt therapy was employed. An overall 5-years' survival rate of 39.8% could be achieved, a value which is above the average reported in world literature. Comparing the last period analysed in the present study (1971 to 1977) with another period 20 years earlier (1951-1956), the following differences can be observed: the fraction of stages III and IV rose markedly from 57.2% to 68.7%; associated with this change was an increase of the percentage of older patients (greater than 60a) from 53.6% to 70.7%. These two developments had an impact on the survival rate: in the total population, it was 39.8% as compared to 32% for the period from 1971 to 1977. The 5-year-survival rate in stage I (n = 60) was 75%, in stage II (n = 95) 45.3%, in stage III (n = 145) 30.3% and in stage IV (n = 62) 19.3%. The incidence of rectovaginal or vesico-vaginal fistulas amounted to 8%. The importance of gynaecological screening for old age patients is emphasized being the only possibility for reducing the high percentage of progressed stages.

A collaboration between gynecologist, radiologist, and gynecologic radiotherapist is necessary in order to diagnose relapses and therapy effects in uterine cervix carcinoma. New imaging methods such as computed tomography, ultrasonography including endo-sonographic procedures and multiple spin echo imaging have to be applied for clinical check-up which is based on the fundamental investigation performed after primary therapy. These methods allow a very precise demonstration of lymph node relapses greater than 2 cm in the wall of the small pelvis as well as of remote metastases. The problem remains to reveal lymph node metastases below 2 cm and beginning recurrences in the cervical and parametrial region after irradiation.

Among recto-vaginal fistulae in 41 patients 22 were due to radiotherapy, 6 to inflammatory disease, 4 occurred as a postoperative complication and 9 were carcinomatous fistulous tracts. Passage of stool or air per vaginam is a pathognomonic sign. The fistula can usually be diagnosed by routine gynaecological examination. Barium enema, barium meal with follow-through or colpography often demonstrate the fistula. Except for a few cases in which the fistula closes spontaneously (most frequently those which occur postoperatively), treatment is surgical. Intestinal resection is often necessary in the inflammatory fistulae and those after radiotherapy. In fistulae due to carcinoma colostomy will improve symptoms: radical removal of the tumour is rarely possible. 31 of the 44 women are cured, while in two a fistula has persisted.

The transmural inflammation in Crohn's disease, the variable localization of the disease and the tendency to a descending spread, all lead to a multitude of possible fistulae, the presence of which is often difficult to demonstrate. This is a report on 5 unusual fistula systems: in 2 cases entero-enteral (one of which with hydronephrosis), 1 case of rectovaginal fistula, 1 case of a branched fistula system in the right buttock, 1 case of fistulae between an abscess system in the spleen "bed" and the greater curvature of the stomach. A radiological and endoscopic diagnosis is important since surgically opened fistula systems heal only with great difficulty or not at all.

Recto-vaginal fistula is comparatively rare. There are certain cases in which it can be removed by means of the pass-through operation, a technique which bears good promise, with no need for cutting through the perineum into the rectum.

Successful treatment of a large vesico-rectovaginal fistula following irradiation of a 53 years old woman. The healing was attained by four steps: 1. Derivation of urine by bilateral nephrostomy. 2. Derivation of faeces by preter-natural anus. 3. Abdomino-vaginal closure of the fistula by Bastiaanse's method. 4. Reposition of the sigmoid. Complete restoration of natural conditons.

The cases of 1013 patients with carcinoma of the cervix are reviewed, who underwent primary radiation treatment in the time from 1951 through 1968. This patient-population is analyzed. The radiation method is described. Out of 1013 women, 496 (49%) survived without recurrences for five years: 80.8% had Stage I disease; 69.7%, Stage II; 38.8%, Stage III; 7.7%, Stage IV. The five-year survival amounted to 53.0%, the relative effectiveness to 61.5 per cent. Complications, side-effects and secondary diseases are reported, as well as the observations of recurrences found by us.

A report is given on three cases of total vaginal necrosis observed between 1980 and 1983 in 156 evaluable patients submitted to primary or postoperative irradiation. Characteristic signs of this disease are the incidence of sudden pains (increased in sitting position), necrosis and ulceration of the complete vaginal area, and a tendency to spontaneous recovery. All patients had been treated by hysterectomy or Wertheim operation, suffered from associated cardiovascular troubles, and had been exposed to a large surface irradiation of the vagina with 75 to 90 Gy. The disease was reversible in two cases, one patient presented a rectovaginal fistula after a latency of three years. Further risk factors for this complication communicated in literature as well as the differential diagnosis of recurrent carcinoma are discussed.

A report is given of 448 cases of corpus carcinoma, treated by primary radiotherapy in the I-st Gynecological University Hospital in the years 1960 to 1968. The 5-years-healing rate in this period was 50.4 percent. It is emphasized that the cases represent a negative selection, as only inbetween the ages of 61 and 90 years. Two women died primarily from pulmonary embolism (0.4 percent). In two patients a rectovaginal fistula developed. The increasing number of patients with diabetes mellitus (23.2 percent) is striking.

Stenoses of the lower intestinal tract following radiotherapy of female genital cancer occur at a frequency of 2-5%; the terminal ileum as well as the sigma are often involved. From 1966-1976 110 patients were treated at the Department of Surgery of the University Hospital of Hamburg. 43 patients required surgical treatment; stenosis of the sigma was the most frequent indication followed by ileus of the small intestines, haemorrhagic proctitis, ulcer of the anterior rectal wall and vesico-recto-vaginal fistula. The following operations were performed: Resection of the small intestines or enterolysis (n = 11), resection of the descending colon (n = 8), abdominal perineal excision of the rectum (n = 4), transversostomy (n = 14) and fistula plastics. - From our experience, intestinal reactions after radiation must be suspected when 1. the total irradiation dose is over 6000 R, 2. radium implants are used, 3. previous operations and abdominal inflammatory lesions restrict the movement of the intestines.