[Surgical treatment of radiation enteritis]

Abstract

Abdomen and pelvic radiation therapy, as a complement to medical and surgery therapy in malignancies, may determine acute and chronic intestinal injuries. The acute intestinal effects of ionizing radiation are the necrosis of crypt epithelial cells and the cessation of the intestinal epithelium; late radiation injury is the result of a progressive vasculitis and diffuse collagen deposition and fibrosis. In this paper we report a clinical case of radiation enteritis and examine different surgical managements, above all complications such as fistulas, stenosis and fibrinous adhesions. As the literature reports, the treatment of choice is a wide resection of the stenotic bowel and occasionally by-pass. In our case we have performed a wide resection. It is extremely important to emphasize the high morbidity and mortality of every surgical approach. We conclude by affirming the important role of physicians and oncologists to perform a correct radiotherapy to avoid the radiation injuries to the intestine; this considering also that the sites of intestinal injuries may not seem readily apparent.