title: Radiation-induced distal ileal obstruction complicating ileostomy closure.
abstract: BACKGROUND
  Radiation enteropathy is a recognized complication in patients who undergo neoadjuvant radiotherapy for locally advanced rectal cancer. Routine formation of defunctioning loop ileostomy in these patients may mask the development of stricturing, terminal ileal and radiation enteropathy which later may complicate the ileostomy closure. Our aim was to assess the preventive techniques and key warning signs.
  
  
  METHODS
  We present two cases of ileostomy closure in patients with occult, radiation-induced, terminal ileal stricture and review the relevant literature.
  
  
  RESULTS
  The first case was complicated by dehiscence of the ileal anastomosis due to undiagnosed, downstream stenosis of the irradiated terminal ileum. A similar terminal ileal stricture was diagnosed in the second case by contrast fluoroscopy enabling an elective ileocolic anastomosis. The literature indicates the importance of identifying such problems prior to loop ileostomy closure.
  
  
  CONCLUSIONS
  Contrast studies before loop ileostomy closure are valuable in limiting the complications of radiation-induced distal ileal obstruction in selected patients.
authors.affiliation: Department of Colorectal Surgery, Beaumont Hospital, c/o St Lukes Ward, Beaumont Road, Dublin 9, Ireland, zakariaz@tcd.ie.
authors.forename: Z
authors.initials: Z
authors.lastname: Zakaria
authors.forename: D
authors.initials: D
authors.lastname: Toomey
authors.forename: J
authors.initials: J
authors.lastname: Deasy
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects*; D004751:Enteritis / Q000209:etiology; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology* / Q000601:surgery; D007081:Ileostomy; D007082:Ileum / Q000528:radiation effects* / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011832:Radiation Injuries / Q000209:etiology*; D012004:Rectal Neoplasms / Q000628:therapy*