Abstract
Radiation-induced vessel injury is described more than a century ago and remains a persistent clinical problem, despite advances in the field of radiation oncology. Treatment of pelvic neoplasms with radiotherapy may result in chronic radiation toxicity, especially Haemorrhagic radiation cystitis and chronic radiation proctitis. We discussed the computed tomography (CT) findings of three cases with a history of radiotherapy to the pelvis presenting with hematuria and hematochezia. Contrast-enhanced CT could diagnose the cause and site of bleed. All these patients were managed successfully by endoscopic coagulation.
Highlights
Radiation therapy is one of the main treatment modalities for pelvic neoplasms
A 72-year-old female patient who had undergone radiotherapy 11 yrs back for carcinoma cervix came with complaints of moderate to severe per rectal bleed for three days and was admitted to our hospital for further management
The mucosal vessels compensate for this ischemia and develop telangiectasia, which is the cause of bleeding. [3]
Summary
Radiation therapy is one of the main treatment modalities for pelvic neoplasms. New modifications and advancements in radiation therapy like external beam and brachytherapy have reduced malignancy recurrence. [1,2] With an improvement in morbidity and mortality, there is an increasing encounter with late radiation toxicities. Fibrosis, and mucosal bleeding due to abnormal leaky telangiectatic vessels are the usual late effects of radiation in the bowel and urinary bladder. [3,4,5] While mild degrees of hematuria and hematochezia can be managed medically, severe bleeding usually requires endoscopic or endovascular interventions. [6] We discuss three cases with a prior history of radiation to the pelvis a few years back, presenting with hematuria and bleeding per rectum.
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