- Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum.
- Acute ( up to three months), Chronic ( 3 months to years later)
- Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate.
- Mucus discharge
- GI bleeding is more common in chronic radiation proctitis than acute radiation proctitis
- Radiation injury extending to genitourinary system
- urethral stenosis
- Ureteral scarring
- Radiation injury extending to small bowel
- Small bowel obstruction
- Small intestine bacterial overgrowth
- Inflammatory bowel disease
- Infectious colitis
- Diversion colitis
- Ischemic colitis
- Chronic graft-versus-host disease
- Stool C.diff toxin along with routine stool cultures
- Specific testing for E.coli 0157:H7
- Ova and Parasite assay including giardia
- CBC, electrolytes, albumin, ESR, CRP
- Endoscopy and biopsy
- Nonspecific findings
- Pallor, friability, ulcerations, bleeding
- Telangiectatic with bleeding
- Avoid biopsy unless malignancy is suspected as facilitate fistula/non healing wound formation
- CT if obstructive symptoms are present
- MRI if suspicion is high for radiation-induced fistulae
- Generally self-limited
- approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover
- Hydration, steroids, +/- 5-aminosalicylate enema, bowel regimen.
- Sucralfate enema
- short-chain fatty acids
- Hyperbaric O2
- Antioxidants: Vitamin A, E, C.
- Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation
- Surgical resection last resort
- Treat outpatient
- Severe cases that are candidates for surgery should be admitted
- Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303. doi:10.1007/s00384-015-2289-4.