SURGICAL-MANAGEMENT OF THE RADIATION-INJU RED SMALL-BOWEL

From 1978 to 1992, 55 patients (48 women : 87 %) with a mean age of 62 years (35-89) underwent 70 operations for radiation injury of the sma ll bowel. Primary pathology treated with radiotherapy was gynecologic cancer (40: 72 %), digestive malignancy (9: 16 %), male genital cancer (4: 7 %), carcinoma of the bladder (2: 3 %). External radiation was p erformed alone (47: 85.5 %) or associated with intracavitary radium or cesium (8: 14.5 %), mean radiation dose was 50 Gy for 35 patients and not specified for 20 but greater than 45 Gy for all patients. Fifteen patients had associated chemotherapy. Latent period between radiation injury and First symptoms was 39 months (1-16 years) and 72 months (3 -26 years) between radiation and surgical treatment. There were 28 sol itary lesions (mean length: 148.5 cm) with 5 associated colonic injuri es, 27 multiple lesions of the small bowel (mean length: 187.5 cm) wit h 21 associated colonic injuries. Twenty-one lesions of the abdominal wall and 13 lesions of the urinary tract were also associated. Ninetee n patients had pre-operative total parenteral nutritional assistance. Surgical treatment was performed for chronic obstruction in 46 patient s, for fistulae in 5 or for an acute complication in 4 (perforating pe ritonitis: 3, occlusion: 1). Operations performed were: small bowel re section (32), associated with bypass (2); internal by-pass (15); disse ction of adhesions and/or stomy (7). Results: Operative mortality was 2 (6.2 %). Morbidity occurred in 16 (29 %) with 3 anastomotic fistulae . Functional results were good for 36 patients (24 resections, 7 by-pa ss), poor for 2 (1 resection). Failure leading to a second operation o ccurred in 15 (5 resections, 8 by-pass). Comments: 1) pre-operative nu tritional assistance improves operative results; 2) intestinal resecti on is preferable to internal by-pass whenever it can be per formed wit hout extreme risk or unacceptable sequelae.