A safe method of gut resection in women with complicated post-radiation enteritis after cervix cancer

Background: Resection of the irradiated gut in women with cervical cancer is complicated by high morbidity and mortality mainly due to accidental injuries to the adjacent intrapelvic structures. To eliminate these injuries a new method is proposed.

Method: Six patients between 41 and 56 years old who had received radiation therapy for cervical cancer were operated on for post-radiation injury of the terminal ileum. All patients underwent partial resection of the irradiated small bowel plus right colectomy. The surgical technique was undertaken so as to leave parts of the small bowel (20 to 45 cm) adherent to the adjacent organs when complete resection was judged precarious.

Results: All patients had an uneventful recovery with 6 to 14 days hospitalization. No complications related to the remaining intrabdominal parts of the gut were observed. All patients died of the primary disease over 1 to 5 years postoperatively.

Conclusion: The method is safe, simple and eliminates injuries to the adjacent structures.

Post-radiation enteritis; Gut resection; Cervix cancer; Surgical treatment

[1] Yeoh E. K., Horowitz M.: "Radiation enteritis". Surg. Gynecol. Obstet., 1987, 165 (4), 373.

[2] Ramirez P. T., Levenback C., Burke T. W., Eifel P., Wolf J. K., Gerhenson D. M.: "Sigmoid perforation following radiation therapy in patients with cervical cancer". Gynecol. Oneal., 2001, 82(1), 150.

[3] Scolapio J. S., Ukleja A., Burnes J. U., Kelly D. G.: "Outcome of patients with radiation enteritis treated with home parenteral nutrition". Am. J. Gastroenterol., 2002, 97 (3), 662.

[4] P ia de la Maza M., Gotteland M., R amirez C., Araya M., Yudm T., Bunout D., Hirsch S.: "Acute nutritional and intestinal changes after pelvic radiation". J. Am. Coll. Nutr., 2001, 20 (6), 637.

[5] Jereczek-Fossa B. A., Jassem J., Badzio A.: "Relationship between acute and late normal tissue injury after postoperative radiotherapy in endometrial cancer". Int. J. Radial. Oneal. Biol. Phys., 2002, 52 (2), 476.

[6] Girvent M., Carlson G. L., Anderson I., Shaffer J., Irving M., Scott N. A.: "Intestinal failure after surgery for complicated radiation enteritis". Ann. R. Coll. Surg. Eng., 2000, 82 (3), 198.

[7] Meissner K.: "Late radiogenic small bowel damage: guidelines for the general surgeon". Dig. Surg., 1999, 16 (3), 169.

[8] Henriksson R., Bergstrom P., Franzen L., Lewin F., Wagenius G.: "Aspects on reducing gastrointestinal adverse effects associated with radiotherapy". Acta Oncol., 1999, 38 (2), 159.

[9] Kinsella T. J., Bloomer W. D.: "Tolerance of the intestine to radiation therapy". Surg. Gynecol. Obstet., 1980, 151 (2), 273.

[10] Mann W. J.: "Surgical management of radiation enteropathy". Surg. Clin. North. Am., 1991, 71 (5), 977.

[11] Deveney C. W., Lewis F. R., Schrock T. R.: "Surgical management of radiation injury of the small and large intestine". Dis. Colon Rectum., 1976, 19 (1), 25.

[12] Sher M. E., Bauer J.: "Radiation-induced enteropathy". Am. J Gastroenterol., 1990, 85 (2), 121.

[13] Dirksen P. K., Matola N. M., Trelford J. D.: "Complications following operation in the previously irradiated abdominopelvic cavity". Am. Surg., 1977, 43 (4), 234.

[14] Coia L. R:, Myerson R. J., Tepper J. E:: "Late effects of radiation therapy of the gastrointestinal tract". Int. J. Radiat. Oneal. Biol. Phys., 1995, 31 (5), 1213.

[15] Cram A. E., Pearlman N. W., Jochimsen P.R.: "Surgical management of complications of radiation-injured gut". Am. J. Surg., 1977, 133 (5), 551.

[16] Deitel M., To T. B.: "Major intestinal complications of radiotherapy Management and nutrition". Arch. Surg., 1987, 122 (12), 1421.

[17] Allendorf J. D. F., Whelan R. I.: "Radiation injury to the small and large bowel". In: Cameron J.L. (ed): "Current Surgical Therapy" 6th ed. St. Louis, Mosby, 1998, 206.