To the Editor.—In the article "Changing Aspects of Radiation Enteropathy," by Morgenstern et al,1 the authors advise avoiding anastomosis in terminal ileal loops following resection for obstruction, fistulization, ulceration, or perforation. They advise resection of the terminal ileum and proximal colon with an ileocolic anastomosis so that the resultant anastomosis remains outside the pelvis.
Loss of the ileocecal sphincter may cause rapid intestinal tract transit; diarrhea due to dumping of bile into the colon, with colonic irritation; and further bacterial colonization of the small bowel due to reflux (this in a bowel already somewhat compromised by radiation therapy).2
If the ileocecal junction can be spared, perhaps the resultant anastomosis can be kept out of the pelvis by other surgical methods.
BRASLOW L. Changing Aspects of Radiation Enteropathy. Arch Surg. 1986;121(10):1212-1213. doi:10.1001/archsurg.1986.01400100124025