Radiotherapy has become one of the important treatment measures for primary and recurrent malignant tumors in the abdomen, and about 50% of pelvic malignant tumors may be treated with radiotherapy. Advances in radiotherapy technology have greatly improved the cure rate of malignant tumors and significantly prolonged patient survival, especially the application of “intensity-modulated radiotherapy” and “conformal radiotherapy” techniques can prevent normal organs from being treated with excessive or bulky irradiation. However, as the number of patients receiving radiotherapy increases, the incidence of radiotherapy-related intestinal injury, especially the serious long-term complications – intestinal obstruction and intestinal fistula – also increases significantly. In most cases, although patients are far from the threat of survival from tumors, severe and complicated radiation enteritis with extra-intestinal fistula leads to inability to eat, severe digestive fluid erosion and uncontrollable abdominal infection, and even combined intestinal obstruction, which often makes patients suffer from pain and seriously affects their quality of life. The characteristic pathological changes are occlusive small artery endocarditis and interstitial fibrosis of the intestinal wall, making the radiation-injured intestinal wall edematous and fragile, with poor healing ability. Radiation injury can cause severe adhesions to the abdominal organs and can result in “pancake fusion” and “frozen pelvis” through scar healing between bowel loops. Therefore, enterocutaneous fistulas in radiation enteritis are mostly surgical complications, mainly due to severe abdominal adhesions during surgery for intestinal obstruction in radiation enteritis, resulting in damage to the abdominal organs and poor tissue healing leading to rupture of the intestinal anastomosis or repair, or, of course, directly due to severe radiation injury. The digestive juices spilled into the abdominal cavity after intestinal fistula erode the surrounding adjacent radiation-injured organs (e.g., bladder, vagina, etc.) and can form complex intestinal fistulas such as small bowel vesicovaginal fistula, small bowel vaginal fistula, rectal vesicovaginal fistula, etc. Therefore, chronic radiation enteritis fistulas are much more difficult to manage surgically than conventional surgery because of the “pancake fusion” and “frozen pelvis”, abdominal infection, double tissue damage due to chemical damage from digestive fluid erosion and radiation injury, and the formation of complex intestinal fistulas. The post-enteric fistula becomes an extremely complex and difficult clinical treatment. The surgical treatment of chronic radiation enteritis intestinal obstruction and intestinal fistula is an important clinical technique that we are well known in the industry, and we treat a large number of patients referred from large tertiary hospitals across the country. In 2010, the patient was operated again due to recurrence of rectal cancer and underwent resection of recurrent rectal cancer mass, uterus and double adnexa, sigmoidostomy and then 6 stages of neoadjuvant chemotherapy after surgery. In June 2014, a large amount of digestive fluid came out from the original surgical incision on the buttocks. The patient had severe pain and could not sleep, and needed intermittent morphine for pain relief, and could only sleep for 2-3 hours a day. Enhanced CT of the abdominopelvic cavity showed postoperative changes of rectal cancer, abnormal density in the operated area, and recurrence was considered possible; fluid and gas accumulation in the pelvic floor, local sinus or fistula formation. After perfecting the preoperative examination, a dissection, intestinal adhesion release, intestinal fistula resection, jejunostomy, ileo-ascending colon anastomosis, jejunostomy and abdominal abscess drainage were performed under general anesthesia on September 25, 2014, during which the patient was seen to have dense adhesions in the pelvic floor, forming a frozen pelvic cavity and pancake-like fusion, which made the operation extremely difficult and took about 7 hours. “finally living like a normal person”. Typical case 2: Li Moumou, a middle-aged male, underwent palliative resection of rectal cancer in a hospital in Beijing in 1979 due to rectal cancer, with partial removal of the sacrococcygeal bone during the operation, and pelvic radiotherapy from 1980 to 1981 (a total of 25 times, 50 Gy). in 2010, he underwent colostomy due to anastomotic stenosis. in 2012, after a bladder drug flush for radiation cystitis, urine was discharged from the rectum and vesico-rectal fistula; at the end of 2012, episodes of intestinal obstruction began; in October 2014, the patient discharged digestive fluid-like material from the urethra, developed severe edema in the urethra with severe pain, and developed a small bowel-vesical fistula. The patient was referred to our hospital by a well-known surgical professor in Beijing after seeking medical help. He was admitted to the hospital for examination: severe redness and swelling of the penis and testicles, light tenderness, inability to urinate normally, and drainage by indwelling catheter; preoperative imaging suggested small bowel-vesical fistula; CT suggested irregular shape of the anterior border of the sacrum, thickening of soft tissue, localized intestinal canal encapsulation, thickening of the bladder wall with air accumulation in the lumen, and rectal-vesical fistula. The patient had severe pain due to urinary tract irritation by digestive fluid, as well as urinary incontinence, requiring adult diapers, and a preoperative nutritional risk score of 4 was performed, and nutritional support was given. The patient was seen to have formed dense adhesions between the small intestine at the bottom of the pelvis and between the small intestine and the bladder, which was difficult to separate and took about 6 hours. Typical case 3: Li Moumou, a middle-aged male, was found to have “right cryptorchid with malignant change” in 2011, and because the tumor was too large to be removed, he was first treated with radiotherapy (30Gy/15f) in a local hospital, and then underwent “pelvic mass resection” in June 2011. In July 2013, intestinal obstruction appeared, and after conservative treatment was ineffective, a dissection was performed at the local hospital in November 2013, during which it was found that “the hepatic flexure of the colon and part of the small intestine were closely adhered to the right side of the abdomen, and the right hemicolectomy was not detectable. The patient’s abdominal cavity was heavily adhered to, and radiotherapy led to severe fibrosis of the abdominal wall, hard to touch, and many doctors confessed that “this stomach feels like a brick, and I don’t know where to After being referred to our hospital by colleagues, the patient was admitted to our hospital for enteral nutrition to improve the nutritional status. In March 2015, under general anesthesia, the patient underwent abdominal dissection, intestinal adhesion release, intestinal fistula and radioactive intestinal segment resection, and lateral ileo-transverse colon anastomosis, and a T-shaped incision was used to avoid the fibrotic part of the lower abdomen. The patient’s operation was extremely difficult due to intestinal fistula, radiotherapy, multiple operations, and intra-abdominal adhesions into a mass, which took about 8 hours. Now the patient is more than 3 months postoperative and has recovered well and is living a normal life in follow-up. Typical case 4: Wang Moumou, an elderly male, was diagnosed with “rectal high-school differentiated adenocarcinoma” in March 2014, due to the huge tumor with multiple lymph node metastases in the mesenteric root. In December 2014, the patient underwent “transabdominal perineal colectomy for rectal cancer” in a hospital in Beijing. In February 2015, the patient’s perineal wound broke down, and intestinal fluid flowed out, with a large volume of about 500-600 ml/day, and intestinal fistula was considered. Due to the erosion of intestinal fluid, the perineal incision was in severe pain and could not be touched, and the patient could not sit or lie down. In April 2015, the patient underwent a general anesthesia for dissection, intestinal adhesion release, resection of intestinal fistula and radioactive intestinal segment, lateral anastomosis of small intestine and ascending colon, and large omental pelvic floor isolation. Intraoperatively, it was seen that the small intestine was densely adherent to the lateral abdominal wall (around the original intestinal fistula), pelvic floor and abdominal wall, and fused in a pancake pattern, forming a frozen pelvic cavity. Now more than 2 months postoperatively, with telephone follow-up, recovery is going well! Typical case 5: Zheng, an elderly female, underwent laparoscopic-assisted radical rectal cancer resection (miles) + hysterectomy and bilateral adnexal resection on March 17, 2014 for rectal cancer and uterine fibroids, with TNM stage T3N0. On review in August 2014, postoperative recurrence of rectal cancer was considered, so radiotherapy (60Gy/30f) was administered, followed by 2-stage chemotherapy (fluorouracil + oxaliplatin ). In November 2014, urine spillage was found at the original surgical incision at the anus, and the presence of bladder fistula was considered. In February 2015, fecal-like spillage was found at the original surgical incision at the perineum, and intestinal fistula was considered. The patient was only able to lie in a flat position and had significant pain in the perineum and the original surgical incision, with continuous urine and fecal outflow. In addition to pain, the main issue was about dignity, and the elderly had once refused visits from friends and relatives except for their loved ones and children. After admission, a nutritional risk score (4 points) was performed and nutritional support treatment was given. The preoperative imaging and CT results suggested postoperative rectal cancer, vesicovaginal fistula and small intestinal fistula signs; on March 25, 2015, under general anesthesia, a dissection was performed, intestinal adhesions were released, radiological damage and intestinal fistula intestinal segment was excised, small intestine ascending colon lateral anastomosis, bilateral ureteral end-lateral anastomosis abdominal wall fistula. The patient was seen to have heavy adhesions in the pelvic floor of the small intestine and ureter, which made the separation difficult and the operation lasted about 6 hours. The patient recovered well after surgery. Prof. Li Yuanxin commented: The pathological characteristics of fibrosis and extensive dense adhesions in the intestinal segment with radiation injury and the chronic progressive natural course of the disease make the surgical treatment of chronic radiation enterocolitis very challenging. Chronic radiation enterocolitis enterocutaneous fistulas are more difficult to operate and more difficult to treat than enterocutaneous fistulas caused by surgical complications alone because of the dual effects of radiation injury and digestive fluid erosion, extremely poor tissue healing ability and more severe tissue adhesion. The ideal surgery for enterocutaneous fistula with chronic radiation enterocolitis is to remove the radiation damaged intestinal segment and the intestinal fistula segment. Anastomotic strategies and techniques for GI reconstruction are very important, such as the selection of the anastomotic intestinal segment (at least one side of the anastomosis is less radiation damaged), anastomotic placement (the area not damaged by radiation), and anastomotic technique (lateral anastomosis with anastomosis). Even so, anastomotic fistulas occur in a small percentage of patients, so intraoperative placement of a double intraperitoneal trocar, close postoperative observation and timely management, and nutritional support are particularly important to prevent catastrophic consequences even if anastomotic fistulas do occur, and can be completely self-healed by gradual replacement of the fine double intraperitoneal trocar, fine tube hydrodynamic pressure, and bioprotein gel sealing, with perfect results. In these cases, we performed “frozen abdominopelvic” intestinal adhesion release, resection of radioactive injury and intestinal fistula, and lateral anastomosis of the small intestine with the colon away from the radiation field, and obtained satisfactory results after surgery. Careful preoperative preparation, adequate preoperative discussion and surgical plan design, application of special surgical strategies and surgical techniques, close postoperative observation and timely management, and perioperative nutritional support are the keys to the success of these surgical treatments. The surgical treatment of intestinal obstruction and intestinal fistula in chronic radiation enterocolitis has become an important technical feature for which we are well known in the industry, and we have “pathologized” the treatment process and “proceduralized” the clinical operation of this disease, forming a unique preoperative evaluation, perioperative nutritional support , surgical strategies, surgical techniques and principles of perioperative management. We have admitted more than 100 cases of chronic radiculitis in the past 3 years, making us one of the largest centers for surgical treatment of chronic radiculitis in China.