Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Radiation Enteritis and Colitis 1263

■Late symptoms and signs (chronic injury, irreversible)

➣Chronic radiation enteritis

➣Small bowel obstruction

➣Malabsorption

➣Fistula (fecaluria, pneumaturia, feculent vaginal discharge)

➣Abscess (with sepsis or peritonitis)

➣Perforation with acute peritonitis

➣Massive intestinal bleeding (rare)

➣Chronic radiation colitis or proctitis

➣Mild to chronic severe rectal bleeding

➣Obstruction secondary to rectal or sigmoid strictures

➣Fistula formation (rectovaginal, rectovesical, cystitis)

➣Necrosis and gangrene with perforation (rare)

tests

Laboratory

Basic Studies: Blood

■Mild to severe anemia, decreased albumin, vitamins B 12 , D, A, and E

deficiencies, abnormal D-xylose test, positive blood cultures

Basic Studies: Urine

■Pyuria, fecaluria, abnormal D-xylose test

Basic Studies: Stool

■Mild to severe steatorrhea, positive FOBT

Imaging

■Plain abdominal films: ileus early and small or large bowel obstruc-

tion late

■Barium contrast studies: small intestinal mucosal edema, separa-

tion of loops, excessive secretions, stricture, tubular appearance, and

absent mucosal markings

■CT: recurrent cancer, nonspecific bowel wall thickening, widened

presacral space, fistulous disease

■Endoscopy/colonoscopy: test of choice for colitis or proctitis; may

reveal mucosal pallor, friability, edema, and telangiectasias

differential diagnosis

■Crohn’s disease, ulcerative colitis, colorectal cancer, small bowel

tumors, celiac disease, intestinal tuberculosis, amyloidosis, sclero-

derma, immunodeficiency states, chronic intestinal ischemia, vas-

culitis, collagen vascular disorders