Major intestinal complications of radiotherapy. Management and nutrition
M. Deitel and T. B. To
Department of Surgery, University of Toronto, Ontario, Canada.
Hospitalization was required in 57 patients for intestinal injuries
following radiotherapy for carcinoma of the cervix, endometrium, ovary,
bladder, rectum, and other primary sites. Intestinal complications included
stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and
ileovesical fistula; 27 patients had multiple intestinal complications.
Operation was necessary in 33 patients, as follows: bowel resections, 18;
colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and
Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks
and six postoperative deaths occurred. Causes of death among the remaining
patients included residual cancer (ten), de novo bowel cancer (two),
radiation injury (four), and unrelated causes (six). Resection to
uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance
of unnecessary adhesiolysis, and long-tube orientation seemed to contribute
to successful operations. Nutritional support was used for repletion,
post-operative fistulas, and short-gut syndrome.
