Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

In recent years there have been several case reports of patients suffering from the so‐called Mirizzi syndrome. Personal experience with 5 patients, together with published data from 19 others, is used to consider whether this syndrome is a true entity. It is concluded that the involvement of the hepatic duct in gallstone disease may result in a wide range of lesions of differing severity with no common pattern. Consequently, the term “Mirizzi syndrome” has no well‐defined meaning and should be abandoned.

A series of 62 patients was studied as regards healing of the perineal wound after proctectomy; 23 patients suffered from ulcerative colitis, 25 from Crohn's colitis, and 14 from polyposis coli. The overall results were in keeping with data from the literature: 73.9 per cent of wounds in patients with ulcerative colitis and 60 per cent of wounds in patients with Crohn's colitis were healed at six months. The worst results were obtained with packing of the perineal wound, especially in inflammatory bowel disease: 61 per cent of those wounds were not healed at six months. Superior results were obtained with conservative surgery, consisting of perirectal excision and intersphincteric resection. With this technique perineal wounds were not healed at six months in 13.6 per cent of patients with inflammatory bowel disease. In the treatment of persistent sinuses after proctectomy, curettage proved disappointing. Better results were obtained with excision of the sinus tract and primary closure of the resulting wound.

The healing of ileal and colonic anastomoses is compared in rabbits. The intestinal segment that contains the anastomosis shows a temporary loss of strength, which is reflected in a decreased bursting pressure. This loss of strength is accompanied by a massive loss of collagen, measured as hydroxyproline, both in ileum and in colon. In ileum, hydroxyproline concentrations, expressed on a dry weight basis, are lowered by 30 per cent, one day after operation. Thereafter, they rise again, after seven days reaching a level that is 40 per cent enhanced as compared with unwounded tissue. Maximal decrease in colon, measured two days after operation, is 40 per cent. After seven days hydroxyproline levels are back at preoperative values. In colon, significant loss of hydroxyproline is also apparent in the intestinal segment proximal to the anastomosis. This phenomenon does not occur in ileum. These results clearly demonstrate that after ileal anastomosis a loss of collagen occurs similar to that in colonic anastomoses. The fact that the loss of collagen is less extensive and more rapidly restored may be important in explaining the lesser incidence of leakage encountered after surgery of the small intestine.