Gastro-Intestinal
Surgery Related Injury
Bowel obstruction:
Any abdominal and pelvic surgery is associated with a small life-long risk for the development of adhesions and bowel obstruction.
As the number of surgeries increases, so does the risk of the development of adhesions.
Different studies in survivors of childhood cancer who have been treated for intra-abdominal tumors and had surgery, show that the overall long-term risk of bowel obstruction for these patients is in the range of 10% or so.
Other factors increase the risk of bowel obstruction as a long term complication of childhood cancer:
- Post-operative complications (such as infection)
- Radiation therapy (RT)
- Intensive chemotherapy (especially alkylators and anthracyclines)
- Due to blind loops of small intestine where bacterial overgrowth occurs
- May occur as a result of scarring from surgery or RT (very often secondary to a combination of both)
- Loop of bowel with poor motility causes stasis
- No mucosal damage
- Patients develop:
- Diarrhoea and steatorrhea
- Accompanied by sugar malabsorption
- Malabsorption of vitamin B12 may occur
- Difficult to diagnose and locate area of stasis
- Glucose malabsorption helps to make diagnosis (glucose hydrogen breath test)
- Initial treatment is with oral antibiotics
Bowel ischemia:
Surgery associated with difficult dissection in the region of the superior mesenteric artery may be associated with bowel ischemia, diarrhoea and malabsorption.
