A Case of Recurrent Bowel Obstruction Caused by Radiation Ileitis Performed Massive Small Bowel Resection

Abstract

An 80-year-old woman presented with the acute onset of abdominal distension and abdominal pain. She had a history of receiving definitive radiotherapy for cervical cancer four years previously. Since then, she had been hospitalized four times for bowel obstruction, when she was treated conservatively. She was diagnosed with bowel obstruction caused by radiation ileitis with a contrast-enhanced computed tomography and a contrast radiography through an ileus tube. We planned elective surgery for recurrent obstruction. In intraoperative findings, intraabdominal adhesion was mild and her terminal ileum was segmentally constricting. Wall thickening and punctate whitening on the serosal surface of the proximal ileum were also observed. We performed laparoscopic ileocecal resection and massive small bowel resection of about 150 cm segment. After the operation, she suffered from short bowel syndrome, but she was relieved by taking antidiarrheal agents and oral dietary supplements. Radiation enteritis can cause intestinal obstruction and fistula formation and is often difficult to treat. We discuss here the treatment options for radiation ileitis and changes in postoperative nutritional status with a review of the literature.