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. 1981 Dec;194(6):716–724. doi: 10.1097/00000658-198112000-00010

Radiation injury of the rectum: evaluation of surgical treatment.

P F Anseline, I C Lavery, V W Fazio, D G Jagelman, F L Weakley
PMCID: PMC1345384  PMID: 7305485

Abstract

One hundred four patients, 80 women and 24 men, with radiation injury of the rectum following treatment for gynecologic and urologic malignancy were studied. In 50 patients, the rectal injury was treated surgically; 54 patients were treated conservatively. The age and sex distributions were the same in each group. In 63 patients, symptoms developed one month to one year after radiotherapy. The longest latent interval was 17 years. Of the 50 surgical patients, 23 had associated small bowel injury. The indications for surgery for the rectal injury were 1) proctitis unresponsive to conservative measures in 14 patients, 2) rectal stricture or fistula or both in 32, and 3) rectosigmoid perforation in four. Forty-one patients had external diversions. Eleven had intestinal continuity restored; six of the 11 had required the stoma for proctitis unresponsive to medical measures. Nineteen patients did not undergo colostomy closure, although symptoms wer greatly improved. Diversion alone was insufficient treatment in the remaining 11 patients. Twenty-six patients died. The 12 deaths in the surgical group comprised four due to residual malignancy, four from postoperative complications, and four from unrelated causes. Of the 14 deaths in the nonsurgical group, 11 died of the primary malignancy and three of unrelated causes. Diversion is considered the safest form of treatment for rectovaginal fistulae, rectal strictures, and proctitis unresponsive to medical measures. Intestinal resection resulted in sharp rise in the morbidity and mortality rates.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bardychev M. S., Kirpeshcheva A. K., Kaplan M. A. Pozdnie luchevye povrzhdeniia kishechnika i ikh lechenie. Med Radiol (Mosk) 1978 Dec;23(12):48–54. [PubMed] [Google Scholar]
  2. Blank W. A. Irradiation injury to the bowel and rectum. Proc R Soc Med. 1970;63 (Suppl):98–100. [PMC free article] [PubMed] [Google Scholar]
  3. Bories-Azeau A., Dayan L., Dieudonné G. Traitement chirurgical des radiolésions du colon gauche et du rectum. J Chir (Paris) 1977;114(1-2):39–50. [PubMed] [Google Scholar]
  4. Boronow R. C. Management of radiation-induced vaginal fistulas. Am J Obstet Gynecol. 1971 May 1;110(1):1–8. doi: 10.1016/0002-9378(71)90204-3. [DOI] [PubMed] [Google Scholar]
  5. Chaitin H. Colostomy in radiation-induced rectal stricture. Dis Colon Rectum. 1971 Mar-Apr;14(2):145–146. doi: 10.1007/BF02560062. [DOI] [PubMed] [Google Scholar]
  6. Cram A. E., Pearlman N. W., Jochimsen P. R. Surgical management of complications of radiation-injured gut. Am J Surg. 1977 May;133(5):551–553. doi: 10.1016/0002-9610(77)90004-6. [DOI] [PubMed] [Google Scholar]
  7. Danjoux C. E. Delayed complications following combination of radiation and chemotherapy. Int J Radiat Oncol Biol Phys. 1979 Mar;5(3):441–443. doi: 10.1016/0360-3016(79)91229-x. [DOI] [PubMed] [Google Scholar]
  8. DeCosse J. J., Rhodes R. S., Wentz W. B., Reagan J. W., Dworken H. J., Holden W. D. The natural history and management of radiation induced injury of the gastrointestinal tract. Ann Surg. 1969 Sep;170(3):369–384. doi: 10.1097/00000658-196909010-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dencker H., Johnsson J. E., Liedberg G., Tibblin S. Surgical aspects of radiation injury to the small and large intestines. Acta Chir Scand. 1971;137(7):692–695. [PubMed] [Google Scholar]
  10. Deveney C. W., Lewis F. R., Jr, Schrock T. R. Surgical management of radiation injury of the small and large intestine. Dis Colon Rectum. 1976 Jan-Feb;19(1):25–29. doi: 10.1007/BF02590847. [DOI] [PubMed] [Google Scholar]
  11. FRIEDMAN N. B. Pathogenesis of intestinal ulcers following irradiation; effects of colostomy and adhesions. AMA Arch Pathol. 1955 Jan;59(1):2–4. [PubMed] [Google Scholar]
  12. GRAY M. J., KOTTMEIER H. L. Rectal and bladder injuries following radium therapy for carcinoma of the cervix at the Radium-hemmet. Am J Obstet Gynecol. 1957 Dec;74(6):1294–1303. doi: 10.1016/0002-9378(57)90017-0. [DOI] [PubMed] [Google Scholar]
  13. Galland R. B., Spencer J. Surgical aspects of radiation injury to the intestine. Br J Surg. 1979 Feb;66(2):135–138. doi: 10.1002/bjs.1800660216. [DOI] [PubMed] [Google Scholar]
  14. HURTIG A. Local hydrocortisone acetate for radiation proctitis. Postgrad Med. 1954 Jan;15(1):37–39. doi: 10.1080/00325481.1954.11711537. [DOI] [PubMed] [Google Scholar]
  15. Jafari K., Thaker P., Jayaram B. Vaginal reconstruction following irradiation complication for cervical cancer. Gynecol Oncol. 1980 Apr;9(2):247–250. doi: 10.1016/0090-8258(80)90033-5. [DOI] [PubMed] [Google Scholar]
  16. Lenner V., Hofmann G., Daniels V. Der Strahlenschaden des Dünn- und Dickdarms. Leber Magen Darm. 1977 Apr;7(2):92–96. [PubMed] [Google Scholar]
  17. LoIudice T., Baxter D., Balint J. Effects of abdominal surgery on the development of radiation enteropathy. Gastroenterology. 1977 Nov;73(5):1093–1097. [PubMed] [Google Scholar]
  18. Marks G. Combined abdominotranssacral reconstruction of the radiation-injured rectum. Am J Surg. 1976 Jan;131(1):54–59. doi: 10.1016/0002-9610(76)90420-7. [DOI] [PubMed] [Google Scholar]
  19. Morgenstern L., Thompson R., Friedman N. B. The modern enigma of radiation enteropathy: sequelae and solutions. Am J Surg. 1977 Jul;134(1):166–172. doi: 10.1016/0002-9610(77)90301-4. [DOI] [PubMed] [Google Scholar]
  20. Mortensen E., Nilsson T., Vesterhauge S. Treatment of intestinal injuries following irradiation. Dis Colon Rectum. 1974 Sep-Oct;17(5):638–643. doi: 10.1007/BF02587114. [DOI] [PubMed] [Google Scholar]
  21. O'Connor T. W., Rombeau J. L., Levine H. S., Turnbull R. B., Jr Late development of colorectal cancer subsequent to pelvic irradiation. Dis Colon Rectum. 1979 Mar;22(2):123–128. doi: 10.1007/BF02586778. [DOI] [PubMed] [Google Scholar]
  22. Palmer J. A., Bush R. S. Radiation injuries to the bowel associated with the treatment of carcinoma of the cervix. Surgery. 1976 Oct;80(4):458–464. [PubMed] [Google Scholar]
  23. Pattermann M., Zimmermann G., Klozenbücher H., Trost A., Waclawiczek H. Zur chirurgischen Therapie aktinischer Darmläsionen. Wien Med Wochenschr. 1978;128(16):546–549. [PubMed] [Google Scholar]
  24. Quan S. H. Factitial proctitis due to irradiation for cancer of the cervix uteri. Surg Gynecol Obstet. 1968 Jan;126(1):70–74. [PubMed] [Google Scholar]
  25. Roswit B., Malsky S. J., Reid C. B. Severe radiation injuries of the stomach, small intestine, colon and rectum. Am J Roentgenol Radium Ther Nucl Med. 1972 Mar;114(3):460–475. doi: 10.2214/ajr.114.3.460. [DOI] [PubMed] [Google Scholar]
  26. Russell J. C., Welch J. P. Operative management of radiation injuries of the intestinal tract. Am J Surg. 1979 Apr;137(4):433–442. doi: 10.1016/0002-9610(79)90111-9. [DOI] [PubMed] [Google Scholar]
  27. Smith J. S., Jr, Milford H. E. Management of colitis caused by irradiation. Surg Gynecol Obstet. 1976 Apr;142(4):569–572. [PubMed] [Google Scholar]
  28. Strockbine M. F., Hancock J. E., Fletcher G. H. Complications in 831 patients with squamous cell carcinoma of the intact uterine cervix treated with 3,000 rads or more whole pelvis irradiation. Am J Roentgenol Radium Ther Nucl Med. 1970 Feb;108(2):293–304. doi: 10.2214/ajr.108.2.293. [DOI] [PubMed] [Google Scholar]
  29. Warren E. W., Callaghan S. The response of male guppies (Poecilia reticutata, Peters) to repeated exposure to an open field. Behav Biol. 1976 Dec;18(4):499–513. doi: 10.1016/s0091-6773(76)92524-4. [DOI] [PubMed] [Google Scholar]

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