Radiation Enteritis and Proctitis Clinical Presentation

Updated: Nov 06, 2019
  • Author: Neelu Pal, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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History and Physical Examination

Acute radiation enteritis occurs in almost all patients undergoing pelvic and abdominal radiation therapy. The degree of symptom severity varies, with approximately 15-20% of patients requiring an altered course of therapy. The most common symptoms are as follows:

  • Cramping abdominal pain
  • Tenesmus
  • Nausea
  • Vomiting
  • Anorexia
  • Diarrhea
  • Hematochezia
  • Fever

The most common clinical finding is generalized abdominal tenderness without peritoneal signs. Rarely, severe acute enteritis is associated with massive hematochezia or bowel perforation.

The clinical symptoms and findings of chronic radiation enteropathy may be difficult to attribute to prior radiation therapy. Clinical manifestations may appear after months or years of subclinical progression. An awareness of the patient’s radiation history and knowledge of the clinical signs and symptoms of the phases of radiation-induced injury enteritis and proctitis allow for timely investigation and treatment. Overly conservative treatment may be just as harmful to a patient as injudiciously timed surgical procedures may be.

Almost all patients who receive more than 1.5 Gy/day develop acute radiation enteritis, either while undergoing therapy or shortly after completion of treatment. In 5-10% of patients, exposure of intestine to a total dose in excess of 50 Gy results in the development of severe chronic radiation enteritis.