Radiation injury to small intestine

Radiation induced stricture of the small intestine occurs in less than 0.5 percent of patients receiving abdominal or pelvic radiation. The incidence, etiology, and pathogenesis of the disease are discussed. The clinical courses of all three patients reported were marked by latent periods varying from 30 months to fourteen years, multiple remissions and exacerbations and variable response to nonoperative therapy. Six operative procedures were performed in these three patients. Anastomotic dehiscence was not seen. Recurrent stricture occurred in two of three patients. In one patient, a reticulum cell sarcoma was found within the confines of the radiation stricture. An adequate trial of nonoperative management is recommended in view of the frequent remissions and exacerbations, as well as a significant incidence of recurrent stricture following surgery. At operation limited dissection of irradiated bowel is advised.