Radyasyon Enterokoliti
Özet
Radyoterapi, özellikle karın ve pelvis içi kanserlerin tedavisinde önemli bir araç olmakla birlikte, radyosensitif olan ince bağırsak ve rektum dokularına kaçınılmaz zararlar verebilmektedir. Bu durum, akut dönemde ishal, karın ağrısı ve tenesmus gibi kendini sınırlayan semptomlarla seyreden, kronik dönemde ise tedaviden aylar veya yıllar sonra ilerleyici fibrozis ve obliteratif endarterit ile ciddi klinik tablolara yol açan radyasyon enterokoliti ve proktitine neden olur. Hastalığın tanısında pelvik radyasyon öyküsü, klinik semptomlar, sigmoidoskopi bulguları ve bilgisayarlı tomografi ile manyetik rezonans görüntüleme gibi radyolojik tetkikler kritik rol oynar. Tedavi yaklaşımları genellikle basamaklı bir patika izler; hafif vakalarda noninvaziv yöntemler (diyet, ilaç tedavileri, sukralfat, kısa zincirli yağ asitleri ve hiperbarik oksijen) tercih edilirken, dirençli kanamalarda argon plazma koagülasyonu, formalin uygulaması ve radyofrekans ablasyon gibi endoskopik termal yöntemler kullanılır. İlaç ve endoskopik tedavilere yanıt vermeyen, bağırsak tıkanıklığı, perforasyon, apse veya fistül gibi ciddi komplikasyonlar geliştiren dirençli kronik vakalarda ise son çare olarak diversiyon stoması veya hastalıklı segmentin rezeksiyonunu içeren riskli cerrahi müdahaleler kaçınılmaz hale gelmektedir.
Although radiotherapy is a vital tool for treating intra-abdominal and pelvic malignancies, it inevitably damages the highly radiosensitive small intestine and rectal tissues. This injury leads to radiation enterocolitis and proctitis, presenting as acute self-limiting symptoms like diarrhea, cramps, and tenesmus, or developing months to years later into chronic conditions driven by progressive fibrosis and obliterative endarteritis. Diagnosis relies heavily on a history of pelvic radiation, clinical symptoms, sigmoidoscopy findings, and advanced radiological imaging such as computed tomography and magnetic resonance enterography. Management strategies generally follow a step-by-step approach; noninvasive options like medical therapies, sucralfate, short-chain fatty acids, and hyperbaric oxygen are used for mild cases, while endoscopic methods including argon plasma coagulation, formalin instillation, and radiofrequency ablation target refractory bleeding. For intractable chronic cases that fail to respond to medical or endoscopic treatments, or for patients presenting with severe life-threatening complications such as strictures, fistulas, abscesses, or perforations, surgical interventions like fecal diversion stoma or bowel resection remain a necessary last resort despite their associated high morbidity risks.
Referanslar
Cao B, Soerjomataram I, BrayWorld F. The global cancer burden. In: Wild CP, Weiderpass E, Stewart BW (eds.) Cancer Report: Cancer Research for Cancer Prevention. 2020.p.16 Available at:http://publications.iarc.fr/586.
Baskar R, Lee KA, Yeo R. Cancer and radiation therapy: current advances and future directions. International Journal of Medical Sciences. 2012; 9(3):193–199. doi:10.7150/ijms.3635
Shadad AK, Sullivan FJ, Martin JD, et al. Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World Journal of Gastroenterology. 2013;19:185-98. doi:10.3748/wjg.v19.i2.185
Andreyev HJ, Davidson SE, Gillespie C, et al. British Society of Gastroenterology; Association of Colo-Proctology of Great Britain and Ireland; Association of Upper Gastrointestinal Surgeons; Faculty of Clinical Oncology Section of the RoyalCollege of Radiologists. Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment forcancer. Gut. 2012;61:179—92. doi: 10.1136/gutjnl-2011-300563
Loge L, Florescu C, Alves A, et al. Radiationenteritis: Diagnostic and therapeutic issues. Journal of Visceral Surgery. 2020;157(6):475-485. doi:10.1016/j.jviscsurg.2020.08.012.
Lakkis Z, Manceau G, Bridoux V, et al. French ResearchGroup of Rectal Cancer Surgery (GRECCAR) and the French National Society of Coloproctology (SNFCP). Management of rectalcancer: the 2016 French guidelines. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.2017;19(2):115–122. doi:10.1111/codi.13550
Rozet F, Hennequin C, Beauval JB, et al. [French ccAFU guidelines — Update 2018—2020:Prostate cancer]. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie.2018;28(Suppl 1):81—132. doi:10.1016/j.purol.2019.01.007
Regimbeau JM, Panis Y, Gouzi JL, et al. French University Association for Surgical Research. Operative and long term results after surgery for chronic radiation enteritis. American Journal of Surgery. 2001;182(3):237–242 doi: 10.1016/s0002-9610(01)00705-x
Grubbé EH. Priority in the therapeutic use of X-rays. Radiology. 1933;21:156–162.
Warren SL, Whipple GH. Roentgen Ray intoxication: IV. Intestinal lesions and acute intoxication produced by radiation in a variety of animals. Journal of Experiental Medicine. 1923;38(6):741–752
Tagkalidis PP, Tjandra JJ. Chronic radiation proctitis. Australian and New Zealand Journal of Surgery. 2001;71:230–237. doi: 10.1046/j.1440-1622.2001.02081.x
Dahiya DS, Kichloo A, Tuma F, et al. Radiation Proctitis and Management Strategies. Clinical Endoscopy. 2022;55(1):22-32. doi: 10.5946/ce.2020.288.
Savides TJ, Jensen DM. Gastrointestinal Bleeding. In: Feldman M (ed) Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11Th ed. Philedelphia. Elsevier; 2021.p.276-312
Beard CJ, Propert KJ, Rieker PP, et al. Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multiinstitutional outcomes study. Journal of Clinical Oncology. 1997;15:223- 229. doi: 10.1200/JCO.1997.15.1.223
Coia LR, Myerson RJ, Tepper JE. Late effects of radiationtherapy on the gastrointestinal tract. International Journal of Radiation Oncology - Biology – Physics. 1995;31:1213-1236. doi: 10.1016/0360-3016(94)00419-L
Kasibhatla M, Clough RW, Montana GS, et al. Predictors of severe gastrointestinal toxicity after external beam radiotherapy and interstitial brachytherapy for advanced or recurrent gynecologic malignancies. International Journal of Radiation Oncology - Biology – Physics. 2006;65(2):98–403. doi:10.1016/j.ijrobp.2005.12.008
Huang EY, Sung CC, Ko SF, et al. The different volume effects of small-bowel toxicity during pelvic irradiation between gynecologic patients with and without abdominal surgery: a prospective study with computed tomography-based dosimetry. International Journal of Radiation Oncology - Biology – Physics. 2007;69:732-9
Trzcinski R, Mik M, Dziki L, et al. "Radiation Proctitis". Cianci P. (ed). Proctological Diseases in Surgical Practice. Croatia. Intech Open. 2018. 10.5772/intechopen.76200.
Ashburn JH, Kalady MF. Radiation-Induced Problems in Colorectal Surgery. Clinics in Colon and Rectal Surgery, 2016;29(2):85–91. doi:10.1055/s-0036-1580632
Portelance L, Chao KS, Grigsby PW, et al. Intensity-modulatedradiationtherapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation International Journal of Radiation Oncology - Biology – Physics. 2001;51(1):261-6. doi: 10.1016/s0360-3016(01)01664-9
Nutting CM, Convery DJ, Cosgrove VP, et al. Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer. International Journal of Radiation Oncology - Biology – Physics. 2000 ;48(3):649-56. doi: 10.1016/s0360-3016(00)00653-2.
Porouhan P, Farshchian N, Dayani M. Management of radiation-inducedproctitis, Journal of Family Medicine and Primary Care: 2019;8 (7) : 2173-2178 doi: 10.4103/jfmpc.jfmpc_333_19
Maturen KE, Feng MU, Wasnik AP, et al. Imaging effects of radiation therapy in the abdomen and pelvis: Evaluating "innocent bystander" tissues. Radiographics. 2013;33(2):599-619. doi: 10.1148/rg.332125119.
Mendelson RM, Nolan DJ. The radiological features of chronic radiation enteritis. Clinical Radiology. 1985;36(2):141-8. doi: 10.1016/s0009-9260(85)80097-0.
Son JH, Kim SH, Cho EY, et al. Comparison of diagnostic performance between 1 millisievert CT enterography and half-standard dose CT enterography for evaluating active inflammation in patients with Crohn's disease. Abdominal Radiology (New York). 2018;43(7):1558-1566. doi: 10.1007/s00261-017-1359-1.
Algin O, Turkbey B, Ozmen E, et al. Magnetic resonance enterography findings of chronic radiation enteritis. Cancer Imaging. 2011;11(1):189-94. doi: 10.1102/1470-7330.2011.0026.
Chen G, Han Y, Zhang H, et al. Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms. Frontiers in Oncology. 2021;11:757973. doi: 10.3389/fonc.2021.757973.
Chen DC, Chen LH, Jin WD, et al.[Magnetic resonance imaging findings of liver injury induced by three-dimensional conformal radiotherapy. Nan Fang Yi Ke Da Xue Xue Bao. 2007;27(2):181-3, 187.
Denton A, Forbes A, Andreyev J, et al. Nonsurgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database of Systematic Reviews. 2002;(1) Article ID CD003455. doi: 10.1002/14651858.CD003455.
Cotti G, Seid V, Araujo S, et al. . Conservative therapies for hemorrhagic radiation proctitis: a review. Revista do Hospital das Clinicas. 2003;58:284-292. doi: 10.1590/s0041-87812003000500008
Housri N, Yarchoan R, Kaushal A. Radiotherapy for patients with the human immunodeficiency virus: are special precautions necessary? Cancer. 2010;116(2):273-83. doi: 10.1002/cncr.24878
Do NL, Nagle D, Poylin VY. Radiation proctitis: current strategies in management. Gastroenterology Research and Practice. 2011;2011:917941. doi:10.1155/2011/917941
Andreyev J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut. 2005;54(8):1051–1054. doi: 10.1136/gut.2004.062596
Grodsky MB, Sidani SM. Radiation proctopathy. Clinics in Colon and Rectal Surgery. 2015;28(2):103-111. doi:10.1055/s-0035-1547337
Andreyev HJ, Wotherspoon A, Denham JW, et al. "Pelvic radiation disease": new understanding and new solutions for a new disease in the era of cancer survivorship. Scandinavian Journal of Gastroenterology. 2011;46(4):389-397. doi: 10.3109/00365521.2010.545832.
Vanneste BGL, Van De VoordeL, de Ridder RJ, et al. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303.doi: 10.1007/s00384-015-2289-4
McKeown DG, Goldstein S. StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Radiationproctitis.
Fuccio L, Guido A, Andreyev HJ. Management of intestinal complications in patients with pelvic radiation disease. Clinical Gastroenterology and Hepatology. 2012;10:1326—34. doi:10.1016/j.cgh.2012.07.017
Ali F, Hu KY. Evaluation and management of chronic radiation proctitis. Diseases of Colon and Rectum. 2020;63:285–287.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). International journal of radiation oncology, biology, physics. 1995;31:1341-1346.
Lee J, Han HJ, Min BS, et al. The Role of Endoscopic Evaluation for Radiation Proctitis in Patients Receiving Intermediate-Dose Postoperative Radiotherapy for Rectal Cancer. Japanese Journal of Clinical Oncology 2018 ;48(11):988–94. doi: 10.1093/jjco/hyy126
Wachter S, Gerstner N. Goldner G, et al.Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2000;54(1):11–19. https://doi.org/10.1016/s0167-8140(99)00173-5
Cancer Therapy Evaluation Program. CommonTerminology Criteria for Adverse Events (CTCAE) Version 5.0 CTEP; c2017 [updated 2017 Nov 27; cited 2022 May 15]. _5x7.pdf.
Rustagi T, Mashimo H. Endoscopic management of chronic ra-diation proctitis. World Journal of Gastroenterology. 2011; 17(41): 4554-4562 doi:10.3748/wjg.v17.i41.4554
Paquette IM, Vogel JD, Abbas MA, et al. Clinical practice guidelines Committee of The American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of chronic radiation proctitis. Diseases of Colon and Rectum. 2018;61:1135-1140.
Sahakitrungruang C, Patiwongpaisarn A, Kanjanasilp P, et al. Randomized controlled trial comparing colonic irrigation and oral antibiotics administration versus 4% formalinapplication for treatment of hemorrhagic radiation proctitis. Diseaes of Colon and Rectum. 2012;55(10):1053-8. doi: 10.1097/DCR.0b013e318265720a. PMID: 22965404.
Bowen JM, Gibson RJ, Coller JK, et al. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) (2019). Systematic review of agents for the management of cancer treatment-related gastrointestinal mucositis and clinical practice guidelines. Supportive care in cancer : Official journal of the Multinational Association of Supportive Care in Cancer. 2019;27(10), 4011–4022. doi:10.1007/s00520-019-04892-0
Wedlake LJ, McGough C, Shaw C, et al. Clinicaltrial: efficacy of a low or modified fat diet for the prevention of gastrointestinal toxicity in patients receiving radiotherapy treatment for pelvic malignancies. Journal of Human Nutrition and Diet. 2012;25:247–259
Lee JK, Agrawal D, Thosani N, et al . ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointestinal Endoscopy. 2019;90(2):171-182.e1. doi: 10.1016/j.gie.2019.04.234.
Omer DS, Coelho NN. Therapeutics in Radiation-induced Proctopathy: A Systematic Review. Journal of Coloproctology. 2022;42(1): 085-098.
Grodsky MB, Sidani SM. Radiationproctopathy. Clinics in Colon and Rectal Surgery. 2015;282:103-111. doi: 10.1055/s-0035-1547337.
Kochhar R, Patel F, Dhar A. et al. Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Digestive Diseases and Sciences.1991;36(1):103–107. doi:10.1007/BF01300096
Henriksson R, Franzén L, Littbrand B. Effects of sucralfate on acute and late bowel discomfort following radiotherapy of pelvic cancer. Journal of Clinical Oncology.1992;10(6):969–975. doi: 10.1200/jco.1992.10.6.969
McElvanna K, Wilson A, Irwin T. Sucralfate paste enema: A new method of topical treatment for haemorrhagic radiation proctitis. Colorectal Disease:the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2014;16:281-284 doi: 10.1111/codi.12507
Hayne D, Vaizey CJ, Boulos PB. Anorectal injury following pelvic radiotherapy. The British Journal of Surgery. 2001;88:1037-1048
Kennedy M, Bruninga K, Mutlu EA, et al. Successful and sustainedt reatment of chronic radiation proctitis with antioxidant vitamins E and C. American Journal of Gastroenterology. 2001;96(4):1080–1084.
Ehrenpreis ED, Jani A, Levitsky J, et al. A prospective, randomized, double-blind, placebo-controlled trial of retinol palmitate (vitamin A) or symptomatic chronic radiationproctopathy. Diseases of the Colon and Rectum. 2005;48(1):1–8.
Patel P, Subhas G, Gupta A, et al. Oral vitamin A enhances the effectiveness of formalin 8% in treating chronic hemorrhagic radiation proctopathy. Diseases of the Colon and Rectum, 2009;52(9): 1605–1609. doi:10.1007/DCR.0b013e3181afbe3a
Clarke RE, Tenorio LM, Hussey JR, et al. Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up. International Journal of Radiation Oncology - Biology - Physics. 2008 Sep 01;72(1):134-143. doi: 10.1016/j.ijrobp.2007.12.048
Tahir AR, Westhuyzen J, Dass J, et al. Hyperbaric oxygen therapy for chronic radiation-induced tissue injuries: Australasia's largest study. Asia Pacific Journal of Clinical Oncology. 2015;11(1):68-77. doi:10.1111/ajco.12289
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2017;47:24–32 doi|:10.28920/dhm47.1.24-32
Cooper JS, Hanley ME. Hyperbaric Treatment Of Radiation Proctitis. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537343/
Karamanolis G, Psatha P, Triantafyllou K, et al. Endoscopic treatments for chronic radiation proctitis. World Journal of Gastrointestinal Endoscopy. 20135(7):308-12. doi:10.4253/wjge.v5.i7.308
Farin G, Grund KE. Technology of argon plasma coagulation with particular regard to endoscopic applications. Endoscopic Surgery and Allied Technologies.1994;2:71–77
Peng Y, Wang H, Feng J, et al. Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review. Gastroenterology Research and Practice. 2018;2018:3087603. doi: 10.1155/2018/3087603. PMID: 29681929; PMCID: PMC5845516.
Swan MP, Moore GTC, Sievert W, et al. Efficacy and safety of single-session argon plasma coagulation in the management of chronic radiation proctitis. Gastrointestinal Endoscopy. 2010;72(1):150–154 doi:10.1016/j.gie.2010.01.065
Sato Y, Takayama T, Sagawa T, et al. Argon plasma coagulation treatment of hemorrhagic radiation proctopathy: the optimal settings for application and long-term out come. Gastrointestinal Endoscopy. 2011;73(3):543–549 doi:10.1155/2018/3087603
Vanneste BG, Van De Voorde L, de Ridder RJ, et al. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Diseases. 2015;30(10):1293-303. doi: 10.1007/s00384-015-2289-4. Epub 2015 Jul 23. PMID: 26198994; PMCID: PMC4575375.
Sebastian S, O’Connor H, O’Morain C, et al. Argon plasmacoagulation as first-line treatment for chronic radiation proctopathy. Journal of Gastroenterology and Hepatology. 2004;19(10):1169–1173. doi: 10.1111/j.1440-1746.2004.03448.x.
Ma TH, Yuan ZX, Zhong QH, et al. Formalin irrigation for hemorrhagic chronic radiation proctitis. World Journal of Gastroenterology. 2015;21(12):3593-8. doi: 10.3748/wjg.v21.i12.3593.
Myers JA, Hollinger EF, Mall JW, et al. Mechanical, histologic, and biochemical effects of canine rectal formalin instillation. Diseases of Colon and Rectum. 1998;41:153–158
Lee SI, Park YA, Sohn SK. Formalin application for the treatment of radiation-induced hemorrhagic proctitis. Yonsei Medical Journal. 2007;48(1):97-100. doi: 10.3349/ymj.2007.48.1.97. PMID: 17326251; PMCID: PMC2628007.
Sarin A, Safar B. Management of radiation proctitis. Gastroenterology Clinics of North America. 2013;42(4):913–925
Pikarsky AJ, Belin B, Efron J, et al. Complications following formalin installation in the treatment of radiation induced proctitis. International Journal of Colorectal Diseases. 2000;15:96–99. doi:10.1007/s003840050240
Biswal BM, Lal P, Rath GK, et al. Intrarectal formalin application, an effective treatment for grade III haemorrhagic radiation proctitis. Radiotherapy and oncology : Journal of the European Society for Therapeutic Radiology and Oncology.1995;35 (03):212–215 doi.:10.1016/0167-8140(95)01565-x
Raman RR. Two percent formalin retention enemas for hemorrhagic radiation proctitis: a preliminary report. Diseases of the Colon and Rectum. 2007;50(07):1032–1039 10.1007/s10350-007-0241-6.
Sharma B, Gupta M, Sharma R, et al. Four percent formalin application for the management of radiation proctitis in carcinoma cervix patients: An effective, safe, and economical practice. Journal of Cancer Research and Therapeutics. 2019;15(01):92–95 doi:10.4103/jcrt.JCRT_393_17
Bansal N, Soni A, Kaur P, et al. Exploring the Management of Radiation Proctitis in Current Clinical Practice. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(6):01-06. DOI: 10.7860/jcdr/2016/17524.7906.
Ventrucci M, Di Simone MP, Giulietti P, et al. Efficacy and safety of Nd: YAG laser for the treatment of bleeding from radiation proctocolitis. Digestive and Liver Disease. 2001;33:230–233. doi: 10.1016/S1590-8658(01)80712-X
Dhaliwal A, Saghir SM, Mashiana HS, et al. Endoscopic cryotherapy: Indications, techniques, and outcomes involving the gastrointestinal tract. World Journal of Gastrointestinal Endoscopy. 2022; 14(1): 17-28 doi: 10.4253/wjge.v14.i1.17]
Greenwald BD, Dumot JA, Abrams JA, et al. Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy. Gastrointesttinal Endoscopy. 2010;71: 686-693 doi: 10.1016/j.gie.2010.01.042]
Jensen DM, Machicado GA, Cheng S, et al. A randomized prospective study of endoscopic bipolar electrocoagulation and heater probe treatment of chronic rectal bleeding from radiation telangiectasia. Gastrointestinal Endoscopy 1997;45: 20-25 doi:10.1016/S0016-5107(97)70298-0
Jao SW, Beart RW, Gunderson LL. Surgical treatment of radiation injuries of the colon and rectum. American Journal of Surgery. 1986;151:272–277.
Onodera H. Reappraisal of surgical treatment for radiation enteritis. World Journal of Surgery. 2005;29(4):459–463, doi:10.1007/s00268-004-7699-3
McCrone LF, Neary PM, Larkin J, et al. The surgical management of radiation proctopathy. International Journal of Colorectal Diseases. 2017;32(8):1099-1108. doi: 10.1007/s00384-017-2803-y.
Thompson SK, Chang EY, Jobe BA. Clinical review: healing in gastrointestinal anastomoses, part I. Microsurgery. 2006;26(3): 131–136 doi: 10.1002/micr.20197.
Hauer-Jensen M, Wang J, Denham JW. Bowel injury: current and evolving management strategies. Seminars in Radiation Oncology. 2003;13(3): 357–371 doi:10.1016/s1053-4296(03)00032-8.
Anseline PF, Lavery IC, Fazio VW, et al. Radiation injury of the rectum: evaluation of surgical treatment. Annals of Surgery. 1981;194:716-724.
Kennedy GD, Heise CP. Radiation colitis and proctitis. Clinics in Colon and Rectal Surgery. 2007;20:64–72. 10.1055/s-2007-970202
Pricolo VE, Shellito PC. Surgery for radiation injury to the large intestine. Variables influencing outcome. Diseases of Colon and Rectum. 1994;37:675-684. doi: 10.1007/BF02054411
Yuan Z-X, Ma T-H, Wang H-M, et al. Colostomy is a simple and effective procedure for severe chronic radiation proctitis. World Journal of Gastroenterology. 2016;22:5598–5608.
Nichols TR. Quality of life in US residents with ostomies assessed via the SF36v2: role-physical, bodily pain, and general health domain. Journal of Wound, Ostomy, and Continence Nursing. 2016;43:280–287.
Persson E, Berndtsson I, Carlsson E, et al. Stoma-related complications and stoma size - a 2-year follow up. Colorectal Disease. 2010;12:971-976. doi: 10.1111/j.1463-1318.2009.01941.x
Kirwan WO, Turnbull RB. The Turnbull-Cutait pullthrough procedure for certain cancers of the rectum and Hirschsprung disease. International Advances in Surgical Oncology. 1981;4:173–187
Guner OS, Tumay LV. Turnbull-Cutait technique without ileostomy after total mesorectal excision is associated with acceptably low early post-operative morbidity. Australian New Zealand Journal of Surgery. 2021;91(1-2):132-138. doi: 10.1111/ans.16412.
Theis VS, Sripadam R, Ramani V, et al. Chronic radiation enteritis. Clinical oncology (Royal College of Radiologists (Great Britain)). 2010;22(1):70—83. doi:10.1016/j.clon.2009.10.003
