Abstract
The management of 14 cases of radiation injury to the intestinal tract over a 4-year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J-reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation-damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J-reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.
Similar content being viewed by others
References
Russell JC, Welch JP. Operative management of radiation injuries of the intestinal tract. Am J Surg 1979;137:433–41.
Browning GGP, Varma JS, Smith AN, Small WP, Duncan W. Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury. Br J Surg 1987;74:31–4.
Loludice T, Baxter D, Balnit J. Effects of abdominal surgery on the development of radiation enteropathy. Gastroenterology 1977;73:1093.
Piver MS, Lele S. Entero-vaginal and enterocutaneous fistulae in women with gynaecologic malignancies. Obstet Gynecol 1976;48:458.
Anseline PF, Lavery IC, Fazio VW, Jagelman DJ, Weakley FL. Radiation injury of the rectum. Evaluation of surgical treatment. Ann Surg 1981;194:716–24.
Donaldson SS, Jundt S, Ricour C, Sarrazin D, Lemerle J, Schweisguth O. Radiation enteritis in children. Cancer 1975;35:1167–78.
Schmitz RL, Chao J, Bartoleme JS. Intestinal injuries incidental to irradiation of carcinoma of the cervix of the uterus. Surg Gynecol Obstet 1974;138:29–32.
Marks G, Mohiudden M. The surgical management of the radiation-injured intestine. Surg Clin North Am 1983;63:81.
Swan RW, Fowler WC, Boronow RC. Surgical management of radiation injury to the small intestine. Surg Gynecol Obstet 1976;142:325–7.
Galland RB, Spencer J. Surgical aspects of radiation injury to the intestine. Br J Surg 1979;66:135–8.
Harling H, Balslev I. Radical surgical approach to radiation injury of the small bowel. Dis Colon Rectum 1986;29:371–3.
Lazorthes F, Fages P, Chiotasso P,et al. Resection of the rectum with construction of a colo-anal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.
Keighley MR, Matheson D. Functional results of rectal excision and endo-anal anastomosis. Br J Surg 1980;67:757–61.
Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg 1982;69:301–4.
Parc R, Tiret E, Frileux P, Moskowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 1986;73:139–41.
Ahlquist DA, Gostout CJ, Viggiano TR, Pemberton JH. Laser therapy for severe radiation-induced rectal bleeding. Mayo Clin Proc 1986;61:927–31.
Goldstein F, Khoury J, Thornton JJ. Treatment of chronic radiation enteritis and colitis with salicylazosulfapyridine and systemic corticosteroids: a pilot study. Am J Gastroenterol 1976;65:201–8.
Mennie AT, Dalley VM, Dinneen LC, Collier HJ. Treatment of radiation-induced gastrointestinal disease with acetylsalicylate. Lancet 1975;2:942–3.
Author information
Authors and Affiliations
About this article
Cite this article
Lucarotti, M.E., Mountford, R.A. & Bartolo, D.C.C. Surgical management of intestinal radiation injury. Dis Colon Rectum 34, 865–869 (1991). https://doi.org/10.1007/BF02049698
Issue Date:
DOI: https://doi.org/10.1007/BF02049698