Abstract
Background
Radiation enteropathy is a recognized complication in patients who undergo neoadjuvant radiotherapy for locally advanced rectal cancer. Routine formation of defunctioning loop ileostomy in these patients may mask the development of stricturing, terminal ileal and radiation enteropathy which later may complicate the ileostomy closure. Our aim was to assess the preventive techniques and key warning signs.
Methods
We present two cases of ileostomy closure in patients with occult, radiation-induced, terminal ileal stricture and review the relevant literature.
Results
The first case was complicated by dehiscence of the ileal anastomosis due to undiagnosed, downstream stenosis of the irradiated terminal ileum. A similar terminal ileal stricture was diagnosed in the second case by contrast fluoroscopy enabling an elective ileocolic anastomosis. The literature indicates the importance of identifying such problems prior to loop ileostomy closure.
Conclusions
Contrast studies before loop ileostomy closure are valuable in limiting the complications of radiation-induced distal ileal obstruction in selected patients.
References
Fleming FJ, Påhlman L, Monson JR (2011) Neoadjuvant therapy in rectal cancer. Dis Colon Rectum 54:901–912
Kennedy GD, Heise CP (2007) Radiation colitis and proctitis. Clin Colon Rectal Surg 20:64–72
Waddell BE, Rodriguez-Bigas MA, Lee RJ, Weber TK, Petrelli NJ (1999) Prevention of chronic radiation enteritis. J Am Coll Surg 189:611–624
Akiyoshi T, Fujimoto Y, Konishi T et al (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34:1937–1942
Haboubi NY, El-Zammar O, O’Dwyer ST, James RJ (2000) Radiation bowel disease: pathogenesis and management. Colorectal Dis 2:322–329
Wijesuriya SR, Hewavisenthi J, Deen KI (2010) Patients with rectal cancer having neoadjuvant chemoradiation do not have increased complications of ileostomy closure. CMJ 55:115–117
Hauer-Jensen M, Wang J, Denham JW (2003) Bowel injury: current and evolving management strategies. Semin Radiat Oncol 13:357–371
Meissner K (1999) Late radiologenic small bowel damage: guidelines for the general surgeons. Dig Surg 42:403–418
Gregory D, Kennedy MD, Heise CP (2007) Radiation colitis and proctitis. Clin Colon Rectal Surg 20:64–72
Somosy Z, Horvath G, Telbisz A, Rez G, Palfia Z (2002) Morphological aspect of ionizing radiation response of small intestine. Micron 33:167–178
O’Brien PH, Jenrette JM, Garvin AJ (1987) Radiation enteritis. Am Surg 53:501–504
Macari M, Balthazar EJ (2001) CT of bowel wall thickening. Significance and pitfalls of interpretation. AJR 176:1105–1116
Pickhardt PJ, Bhalla S, Balfe DM (2002) Acquired gastrointestinal fistulas: classification, etiologies and imaging evaluation. Radiology 224:9–23
Kaiser AM, Israelit S, Klaristenfeld D et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441
Perez RO, Habr-Gama A, Seid VE et al (2006) Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum 49:1539–1545
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Zakaria, Z., Toomey, D. & Deasy, J. Radiation-induced distal ileal obstruction complicating ileostomy closure. Tech Coloproctol 18, 195–198 (2014). https://doi.org/10.1007/s10151-013-0997-8
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DOI: https://doi.org/10.1007/s10151-013-0997-8