How do you manage rectal or bowel perforation from interstitial brachytherapy needles?   

One additional step I take other than the one highlighted is at the time of CT simulation if I notice that, I would pull those needles out either completely or to the point they are not into the wall of OARs. 

Having a needle pass through bowel or bladder is very common. While often a good idea to avoid puncturing those structures, they usually tolerate the small defect and heal. It is imperative that you do not load the source in dwell positions adjacent to normal structures to avoid fistula. The other b...