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December 1987

Major Intestinal Complications of Radiotherapy: Management and Nutrition

Author Affiliations

From the Departments of Surgery (Drs Deitel and To) and Nutritional Sciences (Dr Deitel), University of Toronto and St Joseph's Health Centre, Toronto.

Arch Surg. 1987;122(12):1421-1424. doi:10.1001/archsurg.1987.01400240069012

• 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, postoperative fistulas, and short-gut syndrome.

(Arch Surg 1987;122:1421-1424)