Radiation Injury to the Small Bowel with Special Consideration of Surgical Complications

AbstractLarge studies comparing the surgical outcome of primary versus patch repair in congenital diaphragmatic hernia (CDH) patients are rare. This study aims to evaluate the incidence of surgical complications in both types of CDH repair. PubMed, EMBASE, Cochrane and Web of Science were searched for peer-reviewed articles. Studies on CDH between 1991 and August 2020 were systematically screened and meta-analyses were performed. Primary outcomes of this review were: haemorrhage, chylothorax, recurrences and small bowel obstruction (SBO). A total of 6436 abstracts were screened, after which 25 publications were included (2910 patients). Patch repaired patients have a 2.8 times higher risk on developing a recurrence (20 studies) and a 2.5 times higher risk on developing a chylothorax (five studies). Moreover, they have a two times higher risk on developing a SBO. No studies could be included that evaluated the incidence of surgical haemorrhage between these patients. Although the quality of the studies was relatively low, patch repaired patients have a higher risk on developing a recurrence, chylothorax and small bowel obstruction. Large prospective studies are required to adjust for severity of disease, to reveal the true causative factors in order to minimize the risk on these surgical complications in both types of patients.

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Radical surgical approach to radiation injury of the small bowel

Diseases of the Colon & Rectum ◽

10.1007/bf02555048 ◽

1986 ◽

Vol 29 (6) ◽

pp. 371-373 ◽

Cited By ~ 9

Author(s):

Henrik Harling ◽

Ib Balslev

Keyword(s):

Small Bowel ◽

Surgical Approach ◽

Radiation Injury

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Management of surgical complications of small-bowel diverticulosis

Gastroentérologie Clinique et Biologique ◽

10.1016/s0399-8320(05)80795-x ◽

2005 ◽

Vol 29 (4) ◽

pp. 415-418 ◽

Cited By ~ 5

Author(s):

Badjona Songné ◽

Bruno Costaglioli ◽

Francis Michot ◽

Paul Ténière ◽

Michel Scotté

Keyword(s):

Small Bowel ◽

Surgical Complications

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Volvulus of the Small Bowel in Adults

The American Surgeon ◽

10.1177/000313480907501206 ◽

2009 ◽

Vol 75 (12) ◽

pp. 1179-1182 ◽

Cited By ~ 19

Author(s):

Jaime Ruiz-Tovar ◽

Vicente Morales ◽

Alfonso Sanjuanbenito ◽

Eduardo Lobo ◽

Enrique Martinez-Molina

Keyword(s):

Diabetes Mellitus ◽

Abdominal Pain ◽

Small Bowel ◽

Ct Scan ◽

Bowel Obstruction ◽

Surgical Complications ◽

Diagnostic Method ◽

Small Bowel Volvulus ◽

Previous Abdominal Surgery ◽

Patients With Diabetes

The volvulus of the small bowel is a surgical emergency, causing small bowel obstruction. We performed a retrospective study of all the patients diagnosed and treated with small bowel volvulus between 1977 and 2007 at our institution. One hundred twenty-nine patients were analyzed. Thirty-nine patients presented primary volvulus and 90 secondary ones. The most frequent symptom was sudden abdominal pain. CT scan was the best diagnostic method with an accuracy of 83 per cent. Necrotic small bowel loops appeared in 46.5 per cent of the patients. Eighteen patients had postoperative complications (14%). Mortality rate was 9.3 per cent. A higher mortality is observed among patients with previous abdominal surgeries and cardiopathies. Necrotic loops are associated with higher mortality and incidence of surgical complications; patients with diabetes are associated with a higher incidence of necrotic loops. Cardiopathies are associated with more frequent medical and surgical complications. Recurrence rate was 3.9 per cent associated with simple devolvulation. Primary volvulus are more frequent among males and patients with diabetes. Jejunal location is associated with primary volvulus and these correlate with a higher incidence of necrotic loops. Primary volvulus presents a higher incidence of surgical complications. A bowel obstruction with sudden abdominal pain must be suspicious of small bowel volvulus. The main aim is to achieve an early diagnosis to prevent a necrotic small bowel. CT scan is the imaging test with the best diagnostic accuracy. Primary volvulus, the presence of necrotic loops, and patients with cardiopathies, diabetes mellitus, and with previous abdominal surgery are associated with a worse outcome.

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