Prevention of radiation enteritis with a pelvic mesh sling in children with pelvic malignancies

The purpose of this paper is to assess a method for preventing radiation enteritis in children with pelvic malignancies. Between 1986 and 1991 the authors used polyglycolic acid (Dexon R) mesh slings placed at or above the sacral promontory to maintain all small bowel out of the pelvis during pelvic irradiation therapy in 8 children with pelvic malignancies. There were no complications of mesh placement. Gastrointestinal (GI) symptoms during radiation therapy were limited to diarrhea for 24 hours in 1 of 8 patients. Upper GI series, CT, and MR imaging were used to evaluate the effectiveness of the mesh in maintaining the bowel out of the pelvis, and the response of the tumor to therapy. In all 8 patients radiologic evaluation demonstrated excellent positioning of the small bowel out of the pelvis. The bowel was first noted to descend into the pelvis, probably due to mesh breakdown, at 2-3 months after placement. Further and progressive descent of small-bowel loops, probably because of lysis of adhesions and response of the primary tumor to therapy, were observed over the ensuing 5-6 months. Use of the absorbable pelvic mesh sling appears efficacious in preventing radiation-associated enteritis during pelvic irradiation