Chronical radiation enteritis: anatomo-clinic correlations from a monocentric cohort of 41 patients treated by surgery

Introduction: The aim of our study was 1/characterizing histological lesions of chronic radiation enteritis (CRE), 2/correlating them with clinical presentation, 3/isolating a phenotype associated with a pejorative evolution. Methods: The retrospective study dealt with all patients treated for CRE which required an intestinal resection in our hospital between 2006 and 2017. The histological data where correlated with the initial clinical data and the recurrent clinical symptoms observed during the follow-up (the median follow-up was 32 months [4;180] after resection). Results: 41 patients were included. Among them, there were 39 (95%) women and 2 men. The intestinal resection, brought 60 [10;220] cm of diseased small bowel. The histological findings showed an amyotrophy, villous atrophy, ulcerations observed among 66, 63 and 34% of the panel respectively. The intestinal wall arteries were obliterated among 24 (59%) patients, significantly associated with villous atrophy, ulcerations and an amyotrophy, defining a CRE of ischemic phenotype. CRE with ischemic phenotype was found among patients lately treated by surgery after a radiotherapy (between 13 years ± 2,3 vs 2,6 years ± 0,6, p=0.0002). During the follow-up, a recurrence of occlusive syndrome and the necessity of new intervention was observed among 10 (25%) and 4 (10%) patients respectively. The recurrence was the same whatever could be the histological phenotype. Conclusion: The intestinal wall arteries diffusely obliterated are observed in 59% of CRE and are associated with an ischemic histological phenotype. However, they are not correlated with postoperative recurrence of CRE symptoms. (author)