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Traitement chirurgical des lésions radiques de l’intestin grêle

Surgical management of radiation enteritis of the small bowel

  • Article Original / Original Article
  • Published:
Journal Africain du Cancer / African Journal of Cancer

Résumé

Introduction

La radiothérapie des cancers pelviens expose à la survenue de radiolésions digestives. Mais quand l’atteinte de l’intestin grêle est symptomatique, le traitement chirurgical devient nécessaire en cas de complication.

Matériel et méthodes

Nous rapportons notre expérience, à travers une étude rétrospective sur sept cas d’entérite radique ayant nécessité un geste chirurgical, colligés entre janvier 2005 et décembre 2009.

Résultats

L’âge des patients a varié entre 36 et 76 ans, avec une irradiation pelvienne comprise entre 40 et 60 Gray. La cohorte étudiée comportait cinq femmes. Le diagnostic a été fait en préopératoire chez cinq patients: quatre patients ont été admis pour un syndrome occlusif et une patiente pour fistule externe. Un patient a été opéré en urgence pour une perforation intestinale avec péritonite, et un cas avait présenté une hémorragie digestive basse avec découverte de radiolésion à la laparotomie. Le traitement avait consisté en cinq résections segmentaires avec anastomose, et deux dérivations internes. La morbidité globale était élevée à 43 %. Un patient est décédé suite à un choc septique.

Conclusion

Les indications opératoires en cas d’entérite radique sont d’abord l’échec du traitement médical, les fistules, les hémorragies, les perforations et les sténoses radiques. Les meilleurs résultats fonctionnels sont offerts par la résection intestinale, alors que la dérivation interne n’est réalisée que lorsque les lésions radiques sont trop étendues. Par ailleurs, l’assistance nutritionnelle a considérablement diminué la mortalité.

Abstract

Introduction

The radiotherapy of pelvic cancers exposes to gastrointestinal radiation injury, but when the attained small intestine is symptomatic, the surgical treatment becomes necessary in case of complication.

Materials and methods

We report our experience, through a retrospective study of seven cases of radiation enteritis that required surgery, collected between December 2009 and January 2005.

Results

The patients’ ages ranged between 36 and 76 years, with pelvic irradiation between 40 and 60 Gray. The study cohort included five women. The diagnosis was made preoperatively in five patients: four patients were admitted for intestinal obstruction and one patient for external fistula. One patient was urgently operated for intestinal perforation with peritonitis and one case had submitted a lower gastrointestinal bleeding and diagnostic was performed after a laparotomy. The overall morbidity was high at 43% and one patient died of septic shock.

Conclusion

The indications for surgery in cases of radiation enteritis are the first medical treatment fails, fistula, hemorrhage, perforation and radic strictures. The best functional results are provided by bowel resection, while the internal bypass is performed when the lesions are too extensive radic. Moreover, nutritional assistance has significantly decreased mortality.

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Authors and Affiliations

  1. Service de chirurgie viscérale I, hôpital militaire Mohamed-V, Rabat, Maroc

    A. Bounaim, H. El Kaoui, M. El Fahssi, A. Ait Ali, A. Zentar & K. Sair

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  1. A. Bounaim
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  2. H. El Kaoui
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  3. M. El Fahssi
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  4. A. Ait Ali
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  5. A. Zentar
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  6. K. Sair
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Correspondence to A. Bounaim.

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Bounaim, A., El Kaoui, H., El Fahssi, M. et al. Traitement chirurgical des lésions radiques de l’intestin grêle. J Afr Cancer 4, 73–78 (2012). https://doi.org/10.1007/s12558-012-0196-3

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  • DOI: https://doi.org/10.1007/s12558-012-0196-3

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