Chronic Radiation Enteritis

Clinical

Chronic radiation enteritis is caused by ischemia associated with endarteritis. Five percent of patients receiving 4500-5000 cGy of radiation will develop chronic radiation enteritis. Symptoms include abdominal pain, nausea, vomiting, diarrhea (which may or may not be bloody), and they can manifest anywhere from 6 months to 25 years after exposure. Clinical and radiological findings can mimic inflammatory or infectious disease or recurrent tumor.

Radiological

Imaging findings are related to both active ischemia and chronic changes (fibrosis). Active ischemia causes edema and hemorrhage into the bowel wall, leading to fold thickening and separation of bowel loops. Fibrosis leads to strictures, sinus tracts, and fistulae. Advanced disease can cause obstruction.

Chronic radiation enteritis. Spot film of the terminal ileum demonstrates stenosis of terminal ileum, with multiple fistulae.