Karanikas Michael, Touzopoulos Panagiotis, Mitrakas Alexandros, Zezos Petros, Zarogoulidis Paul, Machairiotis Nikolaos, Efremidou Eleni, Liratzopoulos Nikolaos, Polychronidis Alexandros, Kouklakis George
1st Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
Case Rep Gastroenterol. 2012 Sep;6(3):583-9. doi: 10.1159/000343159. Epub 2012 Sep 18.
Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment.
放射性狭窄是盆腔放疗后一种罕见的并发症，但在评估下消化道梗阻的临床医生心中必须予以重视。在内镜检查在慢性放射性直肠炎中发挥重要作用的同时，对于肠道狭窄的处理也有多种治疗选择。直肠狭窄的治疗一直局限于手术，其发病率和死亡率都很高。因此，一种针对良性直肠狭窄的侵入性较小的治疗方法，即内镜下球囊扩张术（可联合或不联合病灶内注射类固醇），已成为一种常用的治疗方式。我们报告一例通过球囊扩张术及辅助病灶内注射曲安奈德成功治疗的良性放射性直肠狭窄病例。一名70岁女性因子宫腺癌接受盆腔放疗11年后，因腹泻和腹胀2周就诊于急诊室。结肠镜检查发现直肠有一处狭窄，并从狭窄处取了多块内镜活检组织。该狭窄通过内镜下球囊扩张术及病灶内注射曲安奈德进行治疗。该手术似乎成功率很高，并发症发生率很低。活检组织的组织学检查显示直肠黏膜有非特异性炎症改变，未发现因放疗导致的黏膜特异性改变。所有活检均未发现恶性病变。患者在治疗后12个月时无狭窄。
