Asian Journal of Case Reports in Surgery

Small Bowel Obstruction on a Polyp Associated with Radiation Enteritis: Case Report

A. Akhdamch *

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

Y. El Brahmi

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

Dato H. O

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

N. Njoumi

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

M. Anajjar

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

M. El Fahssi

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

A. El Hajjouji

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco.

A. Ait Ali

Department of Visceral Surgery II, Mohammed V Military Teaching Hospital, Mohammed V University, Rabat, Morocco and Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.

*Author to whom correspondence should be addressed.

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Abstract

Aims: Inflammatory pseudopolyp (IPP) is a rare and usually isolated benign lesion arising from the submucosa of the gastrointestinal tract. It is often revealed by an invagination or occlusion when it is located in the small intestine. An inflammatory polyp revealed by an occlusion associated with a radiation graft is a particular situation.

Presentation of the Case: We present the case of an 81-year-old woman with acute intestinal obstruction. Imaging showed a caliber discrepancy in the small intestine. Exploration revealed a stricture and a polypoid lesion in the ileum, resected via enterotomy. Post-operative complications including persistent pain and inflammatory syndrome necessitated a second surgery revealing localized peritonitis, for which an ileostomy was performed at the site of the former enterotomy. The final diagnosis of Inflammatory PP was established by histological examination and immunohistochemical investigation.

Discussion: The Inflammatory pseudopolyp is a benign lesion often revealed by an acute complication in the gravelly localization, the association of a radiation enteritis which is a complication of the abdomino-pelvic radiotherapy, makes the global management of this benign pathology and the decision-making more difficult, considering the complexity to establish the diagnosis; the progressive character of the radiation disease; the risk of progression of the primary cancer as well as the altered nutritional state of the patient reached of this affection.

Conclusion: With the expected increasing prevalence of radiation enteritis [1], it is becoming imperative to improve preventive and therapeutic measures to ensure a better quality of life for affected patients. At the same time, the occurrence of complications associated with small bowel polyps, such as haemorrhage, intestinal obstruction or intussusception, highlights the complexity of management and the importance of an integrated approach to optimise clinical outcomes.

Keywords: Polype grelique, inflammatory pseudopolyp, radiation enteritis, diagnosis, radiotherapy, conservative treatment, small bowel, CT imaging, preventive measures

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