A 65-year-old woman with known radiation history for cervical carcinoma treated 18 years ago presents with symptoms of recurrent small bowel obstruction. CT shows a long segment of thickened small bowel with a transition zone, mesenteric fibrosis, and a 'mesenteric fan sign'. No hernias are present. The mechanism of small bowel obstruction in this patient is best described as:

• A Adhesion-related mechanical obstruction from prior laparotomy
• B Carcinoid tumour with desmoplastic reaction
• C Lymphoma presenting as a stricturing bowel lesion
• D Radiation enteropathy with chronic fibrosis causing luminal stenosis and dysmotility ✓

Explanation

Radiation enteropathy is a chronic progressive condition occurring years to decades after pelvic radiation therapy, characterised by mucosal atrophy, fibrosis, endarteritis obliterans, and dysmotility. The mesenteric fan sign on CT (converging vessels/bowel loops pulled toward a fibrous focus in the mesentery) combined with a long segment stricture and history of pelvic radiation strongly indicates radiation-induced small bowel disease. Surgical management is complex; bypass may be preferred over resection to avoid anastomosis in compromised, fibrosed bowel. Adhesions from prior surgery are considered, but the CT pattern and long disease segment favour radiation fibrosis here.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.