Dietetic-nutritional treatment in chronic radiation enteritis. A complex clinical case

We present a clinical case of chronic radiation enteritis, with follow-up over 34 months, the main features of which were as follows: A 60-year-old female patient with adenocarcinoma of the rectum who required a left hemicolectomy (Hartmann), receiving chemotherapy with fluorouracil and external radiation therapy (45 Gy), presenting sub-occlusive episodes five months later that required a first surgical treatment with release of adhesive bands suggesting radiation enteritis. The patient presented progressive intolerance to oral feeding and nutritional supplements, accompanied by severe malnutrition, requiring parenteral nutrition (PN), endovenous fluid therapy and requiring a second surgical intervention due to persistence of the occlusive condition, with resection of 70 cm of the terminal ileum with ileum-colon anastomosis. The pathological analysis of the segment confirmed chronic radiation enteritis, persisting with clinical manifestations of sub-occlusion and radiological alterations compatible with radiation enteritis on the remaining intestine. The dietetic and nutritional management following admission was exclusive parenteral nutrition for 3 months, receiving formula food with glutamine for four months, associated, after 79 days of intestinal rest, with oral formula diets (Basic formula with amino acids as protein source and Standard diet) and with a gradual reduction in the number of weekly infusion until nutritional autonomy was restored after 10 months with PN, with her nutritional needs being covered completely by the digestive route. Subsequently, a mixed regime was established combining diet therapy with good tolerance and normalization of the nutritional status with a return to weight prior to illness and an improvement in radiation enteritis and biochemical parameters.