Radiation jejunitis and a choleic-acid enterolith. Report of a case

The case history is presented of a woman who developed jejunal stricture complicated by formation of a deoxycholic acid intestinal stone. Development of this condition was attributed to radiation jejunitis following radiotherapy 20 years earlier for uterine adenocarcinoma. At that time, 4 doses of 2000 r each were given over a 4-week period. A 34-cm segment of jejunum was removed surgically and found to contain a stone 2 cm in dia consisting of 60% deoxycholic acid and 12% fatty acids. Jejunal stricture is rare following radiotherapy and a survey showed that, considering the entire digestive tract, the incidence of stricture following pelvic irradiation is not great, varying from 1.6 to 12.1% of 2696 subjects reviewed. The length of time between the end of therapy and the surgical intervention for small-intestinal symptoms averages 261/2 months in a series of 600 patients. Stasis of the intestinal flow would favor bacterial hydrolysis and metabolism of bile cholic acid to deoxycholic acid, thus setting up conditions for the development of enteroliths.