Surgical management of radiation enteritis

Seventy patients (17 men and 53 women) were seen with radiation-injured gut between 1958 and 1984. The median age at treatment with radiotherapy was 54 years. External radiotherapy was used in all cases, combined with internal treatment for cervical cancer. Ninety-seven gastrointestinal lesions were produced. There were 63 strictures, 14 fistulas, 12 perforations, and eight bleeds. The period between radiotherapy and clinical manifestation of the lesion was approximately 2 years, being longest for strictures. The majority of the lesions were in the rectosigmoid or mid and distal small bowel. Sixty-one patients required one or more operations, and review of the operative results up to 1977 showed a high incidence of anastomotic leak and death after resection and primary anastomosis. However, we noticed that the ascending, transverse, and descending colon were relatively free of radiation-induced disease. Since then we have used a nonirradiated part of the colon for one end of the anastomosis. Thus terminal ileal resection has been followed by an ileotransverse anastomosis and rectosigmoid resection by mobilization of the splenic flexure to bring it down for anastomosis. With these techniques there has been one leak in 14 anastomoses and none of the 12 patients have died. These results are significantly better (p less than 0.02) than our previous figures when 14 of 27 anastomoses leaked, with 10 deaths. We conclude that use of nonirradiated bowel for at least one end of an anastomosis significantly improves the results of resection of irradiated bowel.