Radiation proctocolitis

Background

  • 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.

Clinical Features

Uncomplicated

  • Diarrhea
  • Urgency
  • Mucus discharge
  • Tenesmus
  • GI bleeding is more common in chronic radiation proctitis than acute radiation proctitis

Complicated

  • Radiation injury extending to genitourinary system
    • urethral stenosis
    • Cystitis
    • Ureteral scarring
  • Radiation injury extending to small bowel

Differential Diagnosis

Evaluation

  • Labs
    • 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
  • Imaging
    • CT if obstructive symptoms are present
    • MRI if suspicion is high for radiation-induced fistulae

Management

Acute

  • 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.

Chronic

  • Non-invasive
    • Anti-inflammatories
    • Sucralfate enema
    • short-chain fatty acids
    • Hyperbaric O2
    • Antioxidants: Vitamin A, E, C.
  • Invasive[1]
    • Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation
    • Surgical resection last resort

Disposition

  • Treat outpatient
  • Severe cases that are candidates for surgery should be admitted

See Also

External Links

References

  1. 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.