Surgical treatment of radiation injury to the rectosigmoid

Radiation-induced injury to the rectosigmoid, the estimated incidence of which was 5.5%, was studied in 92 patients. The condition was surgically treated in 75 cases. Colostomy alone was undertaken in 40 patients, 37 of whom were greatly improved with no need for further surgery, while two had progression of rectal radiation damage and one died. Excisional surgery was performed in 35 cases--Hartmann procedure in 25 and resection with primary anastomosis in 10 cases. Five of these 35 patients died of operative complications. Of the total 16 colonic anastomoses, four leaked. Our impression is that a differentiated policy of proximal colostomy and intestinal resection is safe and effective, although a significant number of the patients will have a permanent colostomy.