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 and mortality rates.
- Enterolysis, or separating of adhesions, in radiated bowel is associated with a high rate of fistula formation.
- Anastomosis can be performed safely if at least one end of bowel to be connected has not been irradiated. Intestinal bypass procedures without resection may be necessary.