Pediatric radiation enteritis with intestinal failure: A case report and literature review.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
19 Jun 2020
19 Jun 2020
Historique:
entrez:
23
6
2020
pubmed:
23
6
2020
medline:
21
7
2020
Statut:
ppublish
Résumé
Chronic radiation enteritis, a disease secondary to radiation exposure, has been widely reported in adults. However, few studies have described chronic radiation enteritis in children. Early diagnosis is essential, and nutrition management plays an important role in pediatric chronic radiation enteritis management. A Chinese 3-year-10-month-old boy was admitted with vomiting, weight loss (1-2 kg) after radiotherapy for a neuroblastoma. The patient was diagnosed as neuroblastoma (primary site: left adrenal grand; site of metastasis: multiple bone metastasis, bone marrow invasion, intraperitoneal lymph node metastasis) in 2015. Five months after radiotherapy, he showed vomiting and weight loss with stricture in intestine and thickening intestinal wall in imaging finding. His daily intake was not sufficient and extra supplements were needed by intravenous infusion. He had a weight-for-age z score of -5.04, a weight-for-height z score of -6.19, a height-for-age z score of -2.22, and a body mass index-for-age z score of -5.87. The highest level of alanine aminotransferase was 1433 U/L. Those findings established a diagnosis of chronic radiation enteritis with intestinal failure, intestinal stenosis, severe malnutrition, and hepatic dysfunction. This patient was treated by parenteral nutrition with minimal enteral feeding. Other treatments were aiming at complications during hospitalization. The patient weaned off parenteral nutrition finally with nutrition status and quality of life improved. There were no signs of tumor recurrence during the 4-year follow-up. Pediatric radiation enteritis is rare. Our study highlights the characteristics of pediatric chronic radiation enteritis. Nutrition therapy is an important part of the whole therapy strategy in pediatric chronic radiation enteritis.
Identifiants
pubmed: 32569238
doi: 10.1097/MD.0000000000020905
pii: 00005792-202006190-00086
pmc: PMC7310870
doi:
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e20905Références
Wang J, Boerma M, Fu Q, et al. Significance of endothelial dysfunction in the pathogenesis of early and delayed radiation enteropathy. World J Gastroenterol 2007;13:3047–55.
Webb GJ, Brooke R, De Silva AN. Chronic radiation enteritis and malnutrition. J Dig Dis 2013;14:350–7.
Theis VS, Sripadam R, Ramani V, et al. Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 2010;22:70–83.
Andreyev HJ. Gastrointestinal problems after pelvic radiotherapy: the past, the present and the future. Clin Oncol (R Coll Radiol) 2007;19:790–9.
Kalaiselvan R, Theis VS, Dibb M, et al. Radiation enteritis leading to intestinal failure: 1994 patient-years of experience in a national referral centre. Eur J Clin Nutr 2014;68:166–70.
Pironi L. Definitions of intestinal failure and the short bowel syndrome. Best Pract Res Clin Gastroenterol 2016;30:173–85.
Girvent M, Carlson GL, Anderson I, et al. Intestinal failure after surgery for complicated radiation enteritis. Ann R Coll Surg Engl 2000;82:198–201.
Group RTO. RTOG/EORTC late radiation morbidity scoring schema. Available at: https://www.rtog.org/ResearchAssociates/AdverseEventReporting/RTOGEORTCLateRadiationMorbidityScoringSchema.aspx. Accessed July 1, 2019.
Chang LL, Wynn JL, Pacella MJ, et al. Enteral Feeding as an Adjunct to Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy. Neonatology 2018;113:347–52.
Brown RARH, Millar AJW, Werner ID, et al. Radiation enteritis in children. Pediatr Surg Int 1988;3:343–6.
Donaldson SS, Jundt S, Ricour C, et al. Radiation enteritis in children. A retrospective review, clinicopathologic correlation, and dietary management. Cancer 1975;35:1167–78.
Flombaum CD, Berner YN. TPN-induced catch-up of growth in a 22-y-old male with radiation enteritis. Am J Clin Nutr 1989;50:1341–7.
Missohou F. Use of expanders for bowel protection in pediatric pelvic tumor radiation therapy: 15 years of tolerance results. Pract Radiat Oncol 2018;8:e224–30.
Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr 2016;35:247–307.
Algin O, Turkbey B, Ozmen E, et al. Magnetic resonance enterography findings of chronic radiation enteritis. Cancer Imaging 2011;11:189–94.
Arslan H, Etlik O, Kayan M, et al. enterography with lactulose solution: preliminary observations. AJR Am J Roentgenol 2005;185:1173–9.
Cronin CG, Lohan DG, Browne AM, et al. Does MRI with oral contrast medium allow single-study depiction of inflammatory bowel disease enteritis and colitis? Eur Radiol 2010;20:1667–74.
Kayhan A, Oommen J, Dahi F, et al. Magnetic resonance enterography in Crohn's disease: standard and advanced techniques. World J Radiol 2010;2:113–21.
Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 2000;34:137–68.
Klingenberg C, Embleton ND, Jacobs SE, et al. Enteral feeding practices in very preterm infants: an international survey. Arch Dis Child Fetal Neonatal Ed 2012;97:F56–61.
Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev 2013;CD000504.
Salas AA, Kabani N, Travers CP, et al. Short versus extended duration of trophic feeding to reduce time to achieve full enteral feeding in extremely preterm infants: an observational study. Neonatology 2017;112:211–6.
Terrin G, Passariello A, Canani RB, et al. Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newborns. Acta Paediatr 2009;98:31–5.
Kuiken NS, Rings EH, Havinga R, et al. Effect of minimal enteral feeding on recovery in a methotrexate-induced gastrointestinal mucositis rat model. Support Care Cancer 2016;24:1357–64.
Freire MP, Pierrotti LC, Zerati AE, et al. Role of lock therapy for long-term catheter-related infections by multidrug-resistant bacteria. Antimicrob Agents Chemother 2018;62: pii: e00569-00518.
pii: e00569-00518
Li N, Gong J. [Nutrition support trerapy in chronic intestinal radiation damage]. Zhonghua Wei Chang Wai Ke Za Zhi 2014;17:951–4.
Regimbeau JM, Panis Y, Gouzi JL, et al. French University Association for Surgical R. Operative and long term results after surgery for chronic radiation enteritis. Am J Surg 2001;182:237–42.
Dietz DW, Remzi FH, Fazio VW. Strictureplasty for obstructing small-bowel lesions in diffuse radiation enteritis—successful outcome in five patients. Dis Colon Rectum 2001;44:1772–7.