Radiation Colitis: An Uncommon Cause of Hematochezia Diagnosed by Small Bowel Capsule Endoscopy

Abstract

Purpose: A patient with hematochezia and anemia underwent capsule endoscopy to evaluate for small bowel source of anemia. She reported a history of abdominal radiation for uterine cancer 10 years prior to presentation. EGD was normal, and a colonoscopy revealed colitis of the ascending colon which was thought to be radiation-induced. Given her recurrent anemia and hematochezia, a small bowel capsule endoscopy was performed. Review of images revealed a normal duodenum and proximal jejenum. In the distal jejenum, however, multiple abnormalities were visualized (see images). These included lymphangiectasia, severe fibrosis, loss of vascular pattern, and punctate hemorrhage. Findings were suggestive of radiation enteritis. She was placed on iron supplementation with subsequent improvement of anemia. Injury to the GI tract can occur after radiation therapy to the abdomen. Injury is often progressive and may lead to clinical symptomatology such as diarrhea, nausea, weight loss, abdominal pain, intestinal obstruction, and perforation. Physiological changes include altered intestinal transit, reduced bile acid absorption, increased intestinal permeability, bacterial overgrowth, and lactose malabsorption. The diagnosis should be considered in the context of previous radiation history. In a patient with this clinical picture, further correlation with radiological findings (CT scan, small bowel follow through) and endoscopy (capsule endoscopy and colonoscopy) should be performed.Figure: [890] Fibrosis and punctate hemorrhage.Figure: [890] Active oozing from jejenum.