Occlusion of the Small Intestine Associated with Acute Radiation Enteritis: Case Report

A. Akhdamch *

Gynaecological and Mammary Unit, Sidi Mohamed Ben Abdellah National Institute of Oncology, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

A. Kouassi

Gynaecological and Mammary Unit, Sidi Mohamed Ben Abdellah National Institute of Oncology, Rabat, Morocco.

M. Anajjar

Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

M. Ben Moussa

Gynaecological and Mammary Unit, Sidi Mohamed Ben Abdellah National Institute of Oncology, Rabat, Morocco.

F. Tijami

Gynaecological and Mammary Unit, Sidi Mohamed Ben Abdellah National Institute of Oncology, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

H. Hachi

Gynaecological and Mammary Unit, Sidi Mohamed Ben Abdellah National Institute of Oncology, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Background: Radiotherapy for abdominal and pelvic cancers can lead to delayed small intestine damage (radiation enteritis), even years after treatment. This case report highlights the diagnostic challenges and management complexities associated with such late-onset complications.

Case Description: A 57-year-old woman presented 5 months after pelvic radiotherapy with acute intestinal obstruction symptoms (abdominal pain, nausea, vomiting, distension). Imaging revealed a small bowel stricture at the prior hysterectomy site. Despite conservative management, surgical exploration confirmed radiation enteritis and a partial bowel obstruction requiring resection. The patient recovered well and was discharged after 5 days.

Discussion: This case exemplifies the challenges of diagnosing radiation enteritis, often relying on clinical context and imaging. Management is further complicated by potential cancer progression, malnutrition, and progressive damage. While treatment focuses on symptom control, nutrition, and surgery for specific complications, preventive measures are crucial to improve patient outcomes.

Conclusions: As radiotherapy use increases, the prevalence of radiation enteritis is likely to rise. This case emphasizes the need for continued research on optimal prevention strategies and comprehensive management approaches to enhance patients' quality of life.

 

Keywords: Radiation enteritis, diagnosis, radiotherapy, conservative treatment, small bowel, ct imaging, preventive measures


How to Cite

Akhdamch , A., Kouassi , A., Anajjar, M., Moussa , M. B., Tijami, F., & Hachi , H. (2024). Occlusion of the Small Intestine Associated with Acute Radiation Enteritis: Case Report. Asian Journal of Case Reports in Surgery, 7(1), 60–67. Retrieved from https://journalajcrs.com/index.php/AJCRS/article/view/499

Downloads

Download data is not yet available.

References

Mahé MA, Barillot I, Chauvet B. Guidelines for external radio- therapy and brachytherapy: 2nd edition. Cancer Radiother. 2016;20 Suppl:S4-7.

Silvain C, Besson I, Ingrand P, et al. Long-term outcome of severe radiation enteritis treated by total parenteral nutrition. Dig Dis Sci. 1992;37:1065-71.

Kilic D, Ozenirler S, Egehan I, Dursun A. Sulfasalazine decreases acute gastrointestinal complications due to pelvic radiotherapy. Ann Pharmacother. 2001;35: 806-810.

L Loge A, C Florescu B, A Alves ACD, Menahem B. Radiation enteritis: Diagnostic and therapeutic issues. J. Visc Surg. 2020;08:012.

Huiwen Ren, Qi Wu, Zhiqiang Sun, Mingming Fang, Jun Liu, Judong Luo. Research progress and treatment of radiation enteritis and gut microbiota. Radiat Oncol J. 2023 Jun ; 41 (2):61–68.

Martínez Hernández Magro P. Bowel obstruction secondary to radiation enteritis: A case report. Revisita de Gastroenterologia de México. 2015;80(1):111-3.

Hauer-Jensen M, Denham JW, Andreyev HJ. Radiation enteropathy-pathogenesis, treatment and prevention. Nat Rev Gastroenterol Hepatol. 2014;11:470-9.

Andreyev HJ, Wotherspoon A, Denham JW, Hauer-Jensen M. Pelvic radiation disease: New understanding and new solu- tions for aa new disease in the era of cancer survivorship. Scand J Gastroenterol. 2011;46:389-97.

Zimmerer T, Böcker U, Wenz F, Singer MV. Medical prevention and treatment of acute and chronic radiation induced enteritis - is there any proven therapy? A short review. Z Gastroenterol. 2008;46:441-448.

Nuyttens JJ, Robertson JM, Yann D, Martinez A. The position and volume of the small bowel during adjuvant radiation therapy for rectal cancer. Int JJ Radiat Oncol Biol Phys. 2001;51:1271-80.

Martel PH, Deslandes M, Dugue L, Sezeur A, Gallot D, Malafosse M. Radic lesions of the small intestine: Surgical treatment. Annales de chirurgie. 1996;50(°4):312-3 17.

Kennedy GD, Heise CP. Radiation colitis and proctitis. Clin Colon Rectal Surg. 2007;20:64-72.

Emily S. Weg, MD, A Xin Pei, PhD, B Marisa A. Kollmeier, MD, A Sean M. McBride, MD, MPH, A, Michael J. Zelefsky, MDa,∗ Dose-escalated intensity modulated radiation therapy for prostate cancer: 15-Year Outcomes Data. Adv Radiat Oncol. 2019 Jul-Sep;4(3):492–499.

Girvent M, Carlson GL, Anderson I, Shaffer J, Irving M, Scott NA. Intestinal failure after surgery for complicated radiation enteritis. Ann R Coll Surg Engl. 2000; 82:198-201.

Toomey DP, Cahill RA, Geraghty j, Thirion P. Radiation enteropathy. Ir Med J. 2006;99:215-217.

Ilangovan R, Burling D, George A, Gupta A, Marshall M, Taylor SA. CT enterography: Review of technique and practical tips. The British Journal of Radiology. 2012;85(1015):876-886.

Andreyev HJ, Davidson SE, Gillespie C, Allum WH, Swarbrick E. British Society of Gastroenterology; Association of colo proctology of great Britain and Ireland; Association of upper gastrointestinal surgeons; Faculty of clinical oncology section of the royal college of radiologists. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer. Gut. 2012;61:179-92.

Bismar MM, Sinicrope FA. Radiation enteritis. Curr Gastroenterol Rep. 2002;4:361-365.

Onodera H, Nagayama S, Mori A et al. Reappraisal of surgical treatment for radiation enteritis. World J Surg. 2005;29:459-463.

Amiot A, Joly F, Lefevre JH, et al. Long-term outcome after extensive intestinal resection for chronic radiation enteritis. Dig Liver Dis. 2013;45:110-4.

Lawrie TA, Green JT, Beresford M, et al. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Cochrane Database Syst Rev. 2018;1: CD012529.

Hachi H, Bougtab A, Tijami F et al. The surgical treatment of radical lesions of the gretel. Médecine du Maghreb. 2000;n°80.

Regimbeau JM, Panis Y, Gouzi JL, Fagniez PL. French university association for surgical research. Operative and long term results after surgery for chronic radiation enteritis. Am J Surg 2001;182:237-42.

Loge L, Florescu C, Alves A, Menahem B. Radiation enteritis: Diagnostic and therapeutic issues. Journal of visceral surgery. 2020 Dec 1;157(6):475-85.