A case of radiation enteritis complicated by ileus from the ingestion of a foreign body

An 86-year-old woman was referred to our hospital complaining of nausea and vomiting associated with ileus. She had undergone irradiation therapy for uterine cancer at the age of 58 years. Although the patient had received a stomach tube while admitted at the previous hospital, she presented with a severely distended abdomen, and intestinal decompression was thought to be inadequate. A long tube was inserted in the small intestine, but no clinical improvement was observed. Contrast studies of the small intestine showed stenosis over a length of approximately 30 cm at the terminal ileum, with no outflow of contrast medium to the anal side. However, the oral side of the stenotic ileum was visualized on a contrast enema using gastrografin. As a stenotic mechanism was suspected and no clinical improvement had been obtained, a laparotomy was performed. The operation revealed that the ileus had been caused by an ingested plum seed obstructing the stenotic ileum, which had narrowed as a result of surgery for uterine cancer. An ileocecal resection and removal of the foreign body were performed. The postoperative course was good. Foreign body obstruction of the terminal ileum that has become stenotic from a late complication of chronic irradiation enteritis, resulting in ileus, is extremely rare. (author)