To explore the surgical methods and experiences and lessons in perioperative management of radiation-induced enteropathy.

A retrospective review of data from 12 patients with chronic radiation-induced intestinal injury who underwent surgical treatment at the First Hospital of Shanxi Medical University from January 2024 to April 2025. Four patients underwent simple ileostom. Eight patients had resection of the responsible lesion, including 4 modified Bacon procedures, one Parks procedure, one Dixon procedure, and 2 total pelvic reconstructions due to concurrent bladder fistula.

Among the 8 patients who underwent resection, one died due to empty pelvis syndrome; one had intestinal retraction leading to a stoma that could not be reduced; three had their stomas reduced, with anal function pending observation; two stomas awaited reduction; additionally, four patients currently had ileostomies with the lesion pending resection.

Resection of the responsible lesion can cure radiation-induced rectal injury, significantly alleviating clinical symptoms and improving the quality of life for patients. However, perioperative management is challenging and complications are numerous, making the compilation of clinical experiences and lessons regarding this condition necessary.