What treatments are available for bleeding radiation proctitis? Treatments include topical antiinflammatory drugs (steroids, mesalamine enemas, or suppositories), targeted endoscopic application of thermal, bipolar, argon plasma coagulation or laser ablation of telangiectasias, and lastly application of 4% formaldehyde solutions (under controlled situations in the operating room).
What are general principles of managing radiation enteritis? Medical management options are generally exhausted before surgery is contemplated or attempted. Cholestyramine, elemental diets, and total parenteral nutrition are commonly used. Although surgery is not withheld for urgent indications (complete obstruction, perforation, abscess not amenable to percutaneous drainage, bleeding, or unresponsive fistulas), it carries significant morbidity …
What are the pathologic findings of late radiation enteritis? Obliterative arteritis occurs in late radiation enteritis. Severe fibrosis commonly is accompanied by telangiectasia formation. The pelvis may be “frozen” because of incredibly dense adhesions and fibrosis.
Can adhesions be prevented? Absorbable hyaluronate and carboxymethylcellulose membranes lead to a statistically significant reduction in the number and severity of intraabdominal adhesions, although it is unclear if this translates into a reduced future need for operative intervention.
Is treatment of postoperative SBO different from treatment of SBO remote from surgery? Yes. Generally, one waits out an early postoperative obstruction for an indefinite period, as long as there is no evidence of strangulation or impending perforation. Approximately 80% resolve without surgery . Nasogastric suction is the mainstay of treatment for postoperative SBO, whereas “the …
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How is postoperative ileus differentiated from postoperative SBO? This distinction can be extremely difficult. Postoperative ileus generally occurs up to 1 week after operation, whereas postoperative SBO may last 7 to 30 days or longer. SBO is associated with nausea, vomiting, distention, and abdominal pain, whereas an ileus may be associated with painless failure to …
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What is a primary bowel obstruction? Primary bowel obstruction refers to an intestinal obstruction without a known cause such as adhesions or a prior cancer diagnosis. Primary bowel obstructions generally require an operation at some point.