BACKGROUND: Radiation therapy is an effective therapy for advanced cervical cancer. Although generally transient, complications of radiation therapy can become severe and require further intervention. Uterine necrosis is uncommon and the management can be complex. CASE: A 46-year-old African American female with stage IB2 squamous cell carcinoma of the cervix was treated with chemoradiation after an aborted radical hysterectomy. Five months after completion, the patient developed severe pelvic pain and persistent vaginal bleeding. Several biopsies confirmed radiation necrosis without evidence of tumor. Due to the severity of symptoms, the patient underwent a total abdominal hysterectomy. CONCLUSION: Uterine necrosis is a rare, late complication after chemoradiation for cervical cancer. Although several treatment options exist for radiation necrosis, surgical intervention may be necessary in severe cases.