Asymptomatic Rectal Perforation After Radiation for Rectal Cancer: A Diagnostic Dilemma and Role of MRI

Radiation forms a vital part of neoadjuvant treatment in locally advanced rectal cancer (LARC) and recurrent rectal cancers. The adverse effects of radiation are well recognized; however, radiation-induced perforation at the tumour site is very rare and is poorly understood. A symptomatic rectal perforation requires an emergency surgical intervention. However, it may present silently and can give rise to suspicion of disease progression and/or residual disease on imaging. Authors present two cases of silent perforations. Both gave rise to a considerable diagnostic dilemma, which was resolved by careful evaluation with MRI.