Radiation proctitis surgery: Difference between revisions
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{{Radiation proctitis}} | {{Radiation proctitis}} | ||
{{CMG}} {{AE}} | {{CMG}} {{AE}} | ||
==Overview== | ==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== | ||
Surgery is not the first-line treatment option for patients with radiation proctitis.However it is usually reserved for patients with | Surgery is not the first-line treatment option for patients with radiation proctitis as it can lead to severe post-operative complications which include:<ref name="pmid8677984">{{cite journal| author=Babb RR| title=Radiation proctitis: a review. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 7 | pages= 1309-11 | pmid=8677984 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8677984 }}</ref> | ||
* [ | |||
* 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:<ref name="pmid1914719">{{cite journal| author=Lucarotti ME, Mountford RA, Bartolo DC| title=Surgical management of intestinal radiation injury. | journal=Dis Colon Rectum | year= 1991 | volume= 34 | issue= 10 | pages= 865-9 | pmid=1914719 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1914719 }}</ref><ref name="pmid25687266">{{cite journal| author=Wu XR, Liu XL, Katz S, Shen B| title=Pathogenesis, diagnosis, and management of ulcerative proctitis, chronic radiation proctopathy, and diversion proctitis. | journal=Inflamm Bowel Dis | year= 2015 | volume= 21 | issue= 3 | pages= 703-15 | pmid=25687266 | doi=10.1097/MIB.0000000000000227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25687266 }}</ref> | |||
* History of unresponsiveness to medical or endoscopic treatment | |||
* History 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== | ==References== | ||
Latest revision as of 23:44, 6 November 2019
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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:[1]
- 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:[2][3]
- History of unresponsiveness to medical or endoscopic treatment
- History 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
- ↑ Babb RR (1996). "Radiation proctitis: a review". Am J Gastroenterol. 91 (7): 1309–11. PMID 8677984.
- ↑ Lucarotti ME, Mountford RA, Bartolo DC (1991). "Surgical management of intestinal radiation injury". Dis Colon Rectum. 34 (10): 865–9. PMID 1914719.
- ↑ 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.