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Intestinal Radiation Injury Clinical Presentation

  • Author: Rajeev Vasudeva, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Sep 04, 2015
 

History

Symptoms can appear early, within hours of the first treatment session; very shortly after therapy; or months to years after the treatment has ended.

Early presentation

In most situations, patients experience acute symptoms 2-3 weeks into the treatment. Symptoms usually resolve in 2-6 months. Symptoms tend to be self-limited and mild in severity, requiring predominantly symptomatic therapy. The correlation between the severity of mucosal damage and the severity of symptoms appears to be poor.

Symptoms include the following:

  • Anorexia
  • Nausea - More frequent with upper abdominal radiation
  • Vomiting - More frequent with upper abdominal radiation
  • Abdominal cramps - Consequence usually of small intestinal involvement
  • Diarrhea - More often observed as a consequence of pelvic irradiation
  • Tenesmus and mucoid rectal discharge - As a result of rectal involvement
  • Rectal bleeding - As a result of rectal involvement

Late presentation

Symptoms generally are insidious and develop months to years after therapy has ended. Many patients with chronic radiation enteritis may not have a prior history of acute radiation injury. Note the following:

  • Colicky abdominal pain - Most common late symptom, due to partial small bowel obstruction
  • Nausea and vomiting - Consequences of small bowel obstruction
  • Chronic watery diarrhea and/or steatorrhea - Consequence of multiple factors, including malabsorption, bile acid-mediated diarrhea, bacterial overgrowth, impaired motility, and development of fistulas
  • Feculent vaginal discharge or pneumaturia - Consequence of fistula development
  • Tenesmus, mucoid rectal discharge, rectal bleeding, constipation, and decrease in stool caliber - Consequences of rectal involvement
  • Massive intestinal bleeding - Occurs rarely
  • Acute onset of abdominal pain and toxemia - Rare occurrences, consequences of a free perforation
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Physical

Physical examination findings vary, and they can be normal or abnormal depending on the presence or absence of an underlying complication. Note the following potential findings:

  • Weight loss and malnutrition - Consequences of malabsorption
  • Generalized and conjunctival pallor - Consequence of anemia
  • Abdominal tenderness
  • Peritoneal signs - Results of a free perforation
  • Palpable mass on abdominal examination - Possible consequence of an inflammatory response
  • Hyperactive bowel sounds, tinkling, rushes, and audible borborygmi - Possible consequences of bowel obstruction
  • Rectal tenderness and bleeding - Occasional consequences of rectal involvement
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Contributor Information and Disclosures
Author

Rajeev Vasudeva, MD Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD is a member of the following medical societies: American College of Gastroenterology, Columbia Medical Society, South Carolina Gastroenterology Association, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, South Carolina Medical Association

Disclosure: Received honoraria from Pricara for speaking and teaching; Received consulting fee from UCB for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy

Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Society for Gastrointestinal Endoscopy, American Federation for Clinical Research, American Association for the Study of Liver Diseases, American College of Forensic Examiners Institute, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association

Disclosure: Nothing to disclose.

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Intestinal radiation injury. Characteristic mucosal changes observed in radiation proctitis with multiple telangiectasias.
Intestinal radiation injury. Friability and oozing of blood from atrophic-appearing mucosa due to radiation.
Intestinal radiation injury. Appearance of mucosa after therapy with bipolar circumactive probe (BICAP) probe.
This slide illustrates disorderly crypts, fibrosis of lamina propria, and vascular dilatation, all of which are characteristic of colonic injury due to radiation. Courtesy of Ronald Burns, MD, Palmetto Richland Memorial Hospital, Columbia, SC.
A deep rectal ulcer from prostate cancer radiation years ago. Patient presented with significant rectal bleeding.
After 6 months of treatment with daily Canasa (5-ASA) suppositories.
Retroflexed view of the same radiation induced ulcer after 6 months of treatment.
 
 
 
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