Radiation proctocolitis: Difference between revisions
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*Generally self-limited | *Generally self-limited | ||
*approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover | *approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover | ||
*Hydration, steroids, +/- 5-aminosalicylate enema. | *Hydration, steroids, +/- 5-aminosalicylate enema, bowel regimen. | ||
===Chronic=== | ===Chronic=== | ||
Revision as of 12:42, 24 November 2017
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
- 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
- Small bowel obstruction
- Small intestine bacterial overgrowth
- Fistulae
Differential Diagnosis
- Ulcerative colitis
- Crohns disease
- Inflammatory Bowel Disease
- CMV Colitis
- Infectious/parasitic enterocolitis
- Diversion colitis
- Ischemic colitis
- Diverticular colitis
- Chronis graft-versus-host diease
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
- ↑ 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.