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Treating Radiation Enteritis: Surgical Solution to an Oncological Complication

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Radiation enteritis is a medical problem associated with inflammation of the intestine after radiation therapy. Read below to learn about the same.

Medically reviewed by

Dr. Pandian. P

Published At February 17, 2023
Reviewed AtMay 11, 2023

Introduction

Radiation enteritis is a condition that can occur as a side effect of radiation therapy. It is characterized by small or large intestine inflammation, which can cause a range of symptoms such as abdominal pain, diarrhea, nausea, vomiting, and weight loss. Radiation enteritis can occur in cancer and non-cancer patients who have undergone radiation therapy to the pelvic or abdominal area. The condition can be acute (occurring during or shortly after treatment) or chronic (developing months or even years after treatment).

What Is Radiation Enteritis?

Radiation enteritis occurs after radiation therapy and causes intestinal inflammation. When a person receives radiation to the abdomen, pelvis, or rectum, the possibility of radiation enteritis increases. It can result in diarrhea, nausea, vomiting, and stomach cramps. It most frequently affects patients getting radiation therapy for pelvic and abdominal malignancies.

Radiation enteritis is often transient for most patients, and the inflammation typically goes down a few weeks after treatment. However, radiation enteritis may persist long after radiation therapy has ended for some individuals. Therefore, symptomatic relief is the first mode of treatment. Surgery to remove the intestine or tube feeding may be required in extreme circumstances.

What Are the Symptoms Associated with Radiation Enteritis?

Radiation enteritis produces various symptoms in patients. Until the inflammation subsides or heals, the treatment focus is symptom relief. These symptoms are as follows:

  • Some patients experience anemia. Anemia is a decrease in total red blood cell or hemoglobin concentration.

  • Some patients may experience diarrhea and bowel obstruction.

  • Some patients experience frequent nausea and vomiting.

  • Stomach cramps, periodic impulses to use the restroom.

  • Patients feel wave-like stomach cramps, watery diarrhea, mucous discharge from the rectum, and rectal pain and bleeding.

What Can Cause Radiation Enteritis?

The following factors increase the risks of getting radiation enteritis.

  • The size, severity, and length of the radiation treatment, as well as the radiation dosage, influence the associated risk.

  • Patients with high blood pressure are at more risk for radiation enteritis than those with normal blood pressure.

  • Patients with previous stomach surgery or chemotherapy (use of chemicals in cancer treatment) are at increased risk.

  • Diabetic patients with diabetes reduce the body's healing capacity and weaken the immune system.

  • Malnutrition further increases the risks of radiation enteritis.

  • Pelvic inflammatory disease (infection of the female reproductive system) is further increased by radiation enteritis.

How to Diagnose Radiation Enteritis?

The doctor may ask detailed questions regarding the patient's past medical, drug, and surgical history besides an account of the present illness. They would also like to know about bowel motions, onset, duration, appearance, blood in the stool, frequency of bathroom visits, and trigger (food item or drink that caused it) of diarrhea. The doctor will also ask about the patient's diet and medications. A physical examination may be recommended in addition to one or more of the diagnostic tests listed below:

  • Endoscopy - Endoscopy allows visualization of the upper portion of the small intestine by inserting a lighted tube into the mouth.

  • Colonoscopy - A lighted tube is inserted into the colon to visualize the lower portion of the small intestine.

  • Capsule Endoscopy - With capsule endoscopy, the doctor can see parts of the small intestine that other procedures cannot see because the patient will take a tiny pill containing a camera.

  • Imaging Technique - Other imaging examinations, such as an abdominal CT (computed tomography) scan or an upper gastrointestinal series of abdominal X-rays.

What Are the Preventive Measures to be Taken for Radiation Enteritis?

The physician will take the following precautions to lessen the risk of enteritis during radiation treatment:

  • Position the body optimally to protect small intestines during radiation treatment.

  • Preventative techniques include changing the quantity of radiation and placing clips at the tumor site to ensure a more direct radiation exposure.

What Is the Treatment for Radiation Enteritis?

1. Symptomatic Treatment - Cancer radiation therapy causes intestinal inflammation. As a first mode of treatment for radiation enteritis, symptoms are managed until the condition goes away. The physician may advise on dietary modifications, painkillers, and antidiarrheal drugs. Doctors frequently recommend patients with radiation enteritis modify their diet. These modifications are intended to minimize digestive tract irritation. Diet modification, such as the use of low-fat and lactose-free diets. Bacterial overgrowth, if suspected, may be treated with antibiotics.

2. Feeding Tube - A flexible plastic tube inserted directly into the nose or stomach to provide nutrition to patients who cannot eat. Sometimes patients require a feeding tube if radiation enteritis lasts longer than expected.

3. Surgery- Surgery is necessary where abscess (accumulation of pus), perforation (hole formation in intestinal tissue), or fistula (a tube-like connection) develops. There is currently no agreement regarding the surgical approach for intestinal resection or enteric bypass. Surgical treatment of radiation enteritis is associated with high morbidity and mortality rates. Surgery may occasionally be done to bypass the inflamed guts or blocked area or when a person is resistant to medical treatment. Two types of surgeries are performed. These are as follows:

  • Intestinal bypass.

  • Intestinal resection.

What Is Intestinal Bypass Surgery?

The purpose of treatment is to re-route arterial blood flow around a blockage. Surgery is opted for when the intestinal passage becomes too narrow or clogged due to radiation enteritis. Intestinal bypass is preferred to internal resection. However, the intestinal bypass also increases the risks for increased bleeding, abscess, perforation, and bacterial translocation.

What Is Intestinal Resection Surgery?

Short bowel syndrome and the requirement for permanent nutritional support are the main risks with repeated resection surgeries. This resection surgery is indicated in the event of complex, severe, or unresponsive radiation enteritis. The resection and bypass are performed when a fistula or perforation is formed. In intestinal resection surgery, a portion of the gut is removed.

Complications Associated With Intestinal Resection Surgery

1. Change innal Surgery Bowel and Sexual Function - The digestive and bladder functions also vary. Most people see an improvement in these within a few months, but it can take longer for some. In addition, after rectal cancer surgery, erection issues may arise.

2. Fatigue - After surgery, patients may feel exhausted. The doctor may advise patients to maintain an active lifestyle and engage in low-intensity exercise.

Conclusion

Overall, the advantages of radiation therapy for cancer treatment exceed the dangers of radiation enteritis. For this reason, radiation therapy is most often continued. However, in case of any queries regarding radiation enteritis and its effect on their health, it is always advisable to talk to a physician. Possibilities, including dosage alteration, radiation frequency, or alternative ways to overcome radiation enteritis symptoms, may be discussed, advised, and implemented as necessary.

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Dr. Pandian. P
Dr. Pandian. P

General Surgery

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