For which of the following consequences of radiation injury of the intestine is urgent laparotomy required?

B. Colonic perforation.

DISCUSSION: Patients who have symptoms of vascular compromise or evidence of perforation require urgent laparotomy. Patients with small bowel obstruction may require a laparotomy if a complete obstruction persists, but gastrointestinal decompression and hydration are first steps. Patients with radiation-induced rectovaginal fistula may require temporary or even permanent colostomy, but the first steps are evaluation and control of sepsis. Malabsorption and diarrhea can generally be controlled pharmacologically. Rectal stenosis can usually be managed without laparotomy.