Around 75% of thepatients submitted to radiotherapy for prostate cancer will develop anorectalsymptoms, such as fecal urgency, bleeding, rectal pain and tenesmus. Perinealnecrosis is a very rare event in these cases. The purpose of this report isthe description of a diffuse perineal necrosis due to radiotherapy for the treatmentof prostate cancer. This is a report of a 77-year old male, submitted to radiotherapywith 70 Gy of pelvic radiation for prostate cancer treatment. He came to outpatientpractice after 4 months with anorectal complaints. Further investigation revealedsevere radiation proctitis, with a perineal wound and external anal sphincterdamage. The patient was submitted to a loop transverse colostomy with extendedperineal debulking due to diffuse necrosis of pelvic structures, such as prostate,pelvic floor muscles and anterior rectal wall. Hyperbaric oxygen therapy wasstarted for the extended perineal wound, with success. Prevention is the keyto avoid radiation damage in pelvic organs. Doses above 70 Gy are associatedwith high risk of associated pelvic complications. The treatment of diffuseperineal necrosis must be prompt and aggressive. Fecal diversion is mandatoryin cases with extended sphincter destruction.
