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Intestine radiation damage: diagnosis
Last reviewed: 23.04.2024
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Diagnosis of radiation enteritis and enterocolitis helps a carefully collected history. The establishment of radiation therapy or contact with ionizing radiation in the past makes it possible to diagnose radiation damage to the intestine with a high degree of probability. X-ray examination of the abdominal organs already in the early stages of radiation enteritis can detect intestinal obstruction, edema of the small intestine mucosa, enlargement and hypotension of the intestinal loops, expressed spasm of the rectum. In the subacute stage of radiation damage, the swelling of not only the intestinal wall but also the mesentery is revealed. Extensive edema leads to thickening and straightening of the folds of the mucous membrane, the appearance in it of uneven protrusions. Rarely observed isolated ulcers of the anterior wall of the rectum and, if the surrounding mucous membrane is sharply edematous, the radiographic pattern resembles a cancer. The absence of gaustration can simulate other ulcerative lesions of the intestinal mucosa, in particular ulcerative colitis.
In chronic radiation enteritis and enterocolitis, examination of the small intestine with a suspension of barium sulfate along with mucosal edema show signs of impaired absorption, disconnection of the intestinal loops and pronounced secretion in the lumen of the gut. Progressing fibrosis contributes to constriction, fixation, tubularity, loss of elasticity of the intestinal segment or segments in which the mucous membrane is sometimes practically absent. A similar radiographic pattern resembles Crohn's disease or ischemic constriction. Functional small intestinal obstruction can be without a mechanical obstruction in the lumen of the intestine due to a violation of its motor activity.
With enterocolitis, in addition to changes in the small intestine, X-ray reveals changes in the thick and often rectosigmoidal part of it, which is often narrowed, straightened, and some segments are devoid of haustra, which resembles chronic ulcerative or granulomatous colitis. In a number of cases, ulcers are noted in the colon, fistulous passages to the pelvic organs, fibrosis of its wall.
Some help in the differential diagnosis of nonspecific diseases of the intestine, radiation enteritis and enterocolitis is provided by mesenteric angiography and colonoscopy. The defeat of arterioles with ischemic changes confirms the pathological process of radiation genesis. Colonoscopy can detect acute and chronic radiation damage to the mucous membrane of the large intestine. Depending on the stage of the lesion, there are edema, granularity, friability, paleness and dullness of the mucosa and injected submucous dilated vessels. They help to diagnose samples for absorption of various substances, study of parietal digestion, duodenojunctional contents and feces for dysbiota-riosis, morphological examination of biopsy specimens of the mucosa of the small and large intestine.
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