Radiation proctitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Surgery is not the first-line treatment option for patients with radiation proctitis.However it is usually reserved as a last resort for patients with refractory symptoms and complications.

Surgery

Surgery is not the first-line treatment option for patients with radiation proctitis as it can lead to severe post-operative complications which include:

  • Significant bleeding
  • Sepsis
  • Inadvertent enterotomies
  • Formation of fistula
  • Short bowel syndrome due to extensive bowel resection
  • Creation of blind loops due to excessively long bypassed segments
  • Nonhealing of anastomoses performed on irradiated tissue
  • Anastomotic leak with peritonitis sepsis

However it is usually reserved as a last resort for patients with:[1][2]

  • Hx of unresponsiveness to medical or endoscopic treatment
  • Hx of intractable symptoms/complications like stricture, pain, bleeding, perforation, or a fistula.

Surgical options for radiation proctitis include:

  • excision
  • urinary and fecal diversion (diverting stoma) and
  • reconstruction of a coloanal J reservoir

References

  1. Lucarotti ME, Mountford RA, Bartolo DC (1991). "Surgical management of intestinal radiation injury". Dis Colon Rectum. 34 (10): 865–9. PMID 1914719.
  2. Wu XR, Liu XL, Katz S, Shen B (2015). "Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis". Inflamm Bowel Dis. 21 (3): 703–15. doi:10.1097/MIB.0000000000000227. PMID 25687266.

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