Pathophysiology and Surgical Treatment for Radiation Enteritis

Hisashi Onodera, Tae Bun Park, Masato Hasegawa, Yoshihiro Yamazoe, Tadahiro Sakamoto, Hiroshi Inoue, Yoshiki Takeuchi, Daisuke Ikeuchi, Masayuki Imamura, Shunzo Maetani

First Department of Surgery and Research Center for Biomedical Engineering, Kyoto University

We analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. 1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (70%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. 2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two patients developed perforative peritonitis. 3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anasotmoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesions are best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage.

Key words
radiation enteritis, extensive smalll bowel resection, pull-through operation, short bowel syndrome, quality of life

Reprint requests
Hisashi Onodera First Department of Surgery, Faculty of Medicine, Kyoto University
54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606 JAPAN

Accepted
September 8, 1993

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