Case Report

Recurrent Mechanical Small Bowel Occlusion due to Mucosal Diaphragm: A Pelvic Radiotherapy Complication?

Francesco Mongelli, Matteo Di Giuseppe, Michele Marengo and Davide La Regina
World Journal of Medical and Surgical Case Reports 2017, 6:8

Abstract

Introduction

Radiation therapy plays an important in patient with pelvic cancer. Few cases are reported in the literature of mechanical small bowel occlusion resulting from radiotherapy. No cases of endoluminal disease are reported.

Case report

A 73-year old man treated with pelvic radiotherapy for a prostate adenocarcinoma presented to our emergency department with a mechanical small bowel obstruction. A diagnostic laparoscopy was performed without intra-operative identification of bowel adherences. Over the following months, the patient continued to be symptomatic for spontaneously resolving small bowel obstructions, thus a videocapsule endoscopy was performed. 2 days later the patient represented to the emergency department, where a x-ray of the abdomen localised the videocapsule within the small bowel with imaging revealing a gut stenosis. The patient underwent a laparoscopic assisted ileal resection, with intraoperative and histopathological findings showing an endoluminal mucosal bridge causing a stricture.

Conclusions

The frequency of small bowel endoluminal disease is probably underestimated but it should be taken into account in patients with recurrent SBO symptoms after pelvic radiotherapy. In these cases the videocapsule endoscopy is a valuable diagnostic tool while the patency capsule test would have been indicated in a suspected bowel occlusion or stenosis before the videocapsule endoscopy, and probably should have been considered in this case.

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