Radiation damage to the small intestine

Although radiation therapy has proven effective in both cancer control and cure, grave side effects may occur. Among the most serious treatment complications encountered by a patient with malignant disease is that of radiation injury to the small intestine. Patients with gynecologic malignancies are most often found to have these problems of therapy. The etiology of radiation damage at the cellular level is mostly molecular damage resulting in lethal cellular injuries. Accompanying vascular and connective tissue may also be altered and cause later complications. Because of the complex nature of the patient's malignant disease and treatment, diagnosis of radiation injury to the small bowel and other pelvic structures can be most difficult to determine. The management of acute manifestations of enteric radiation injury includes diet modification and drugs that affect intestinal motility. Long‐term manifestations of enteric radiation injury present more serious difficulties. Initially, the patient must be stabilized to reverse the effects of chronic malnutrition, sepsis, and electrolyte imbalance. Immediate surgery may be necessary in patients with suspected perforation. Most patients, however, require further studies for complete assessment of clinical damage. In patients with enteric fistulas, an operation is always necessary for fistula control. Complete enteric bypass utilizing minimally affected intestine is mandatory to ensure the least morbidity and mortality. Prevention of enteric radiation injury requires efforts to minimize postoperative adhesions, avoidance of excessive therapy to segments of fixed small bowel, and dosimetry alteration when complications arise during initial therapy.