Radiation enteropathy: prevention and treatment

Abstract

Surgical considerations in the management of radiation-induced injury of the gastrointestinal tract include the prevention of future radiation injury and treatment of the complications of established chronic radiation enteropathy. At the time of operation for abdominal or pelvic malignancy, the surgeon must be aware of the indications for and techniques of postoperative radiation therapy. Careful preoperative staging and close cooperation between the surgeon and the radiation therapist should allow for the planning of measured designes to position the small bowel intraoperatively such that it will receive the minimal possible radiation exposure during the course of postoperative radiotherapy. Surgical management of chronic radiation enteropathy is concerned with treatment of the complications of obstruction, fistulization, infection and bleeding. The distal small intestine and the rectum are the areas involve most frequently. Partial obstructive symptoms are best treated nonoperatively until complete obstruction ensues on until the symptoms are incapacitating. These operations can be extremely difficult. Principles of operative management include resection (whenever feasible and safe) with primary anastomosis between healthy, nonirradiated segments of bowel. Radiation proctitis is also best managed conservatively with laser therapy of rectal bleeding and supportive care of symptomatic tenesmus. When symptoms are sufficiently severe to warrant surgical intervention, protectomy with a permanent end-sigmoid colostomy is the treatment of choice. Fistula formation and pelvic sepsis are the most challenging complications associated with radiation enteropathy and may require staged procedures for management.