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Radiation proctocolitis is a common side effect of radiation therapy. In rare cases, chronic radiation injury can be severe enough to cause rectal necrosis. In this study, a case of rectal necrosis after sacral spine radiotherapy was presented. Anterior rectal wall necrosis and rectovaginal fistula is thought to be rare, severe and challenging rectal long-term complication of the previous sacral spine irradiation. Although, rectovaginal fistula which resulted in intractable rectal bleeding seems to be a rare side-effect of radiotherapy, physicians must not forget about this complication, as it can be fatal in patients who often have been cured of cancer.