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Radiation-induced intestinal lesions - Diagnosis
Last reviewed: 04.07.2025
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Diagnosis of radiation enteritis and enterocolitis is aided by a carefully collected anamnesis. Evidence of radiation therapy or contact with ionizing radiation in the past allows for a high probability of diagnosing radiation damage to the intestine. X-ray examination of the abdominal organs can already in the early stages of radiation enteritis detect intestinal obstruction, edema of the small intestinal mucosa, dilation and hypotension of the intestinal loops, and severe spasm of the rectum. In the subacute stage of radiation damage, edema of not only the intestinal wall but also the mesentery is detected. Extensive edema leads to thickening and straightening of the folds of the mucous membrane, and the appearance of uneven protrusions in it. Isolated ulcers of the anterior wall of the rectum are rare, and if the surrounding mucous membrane is sharply edematous, the X-ray picture resembles cancer. The absence of haustration can simulate other ulcerative lesions of the intestinal mucosa, in particular nonspecific ulcerative colitis.
In chronic radiation enteritis and enterocolitis, examination of the small intestine with a barium sulfate suspension, along with mucosal edema, reveals signs of impaired absorption, separation of intestinal loops, and pronounced secretion into the intestinal lumen. Progressive fibrosis contributes to narrowing, fixation, tubularity, loss of elasticity of the intestinal segment or segments, in which the mucosa is sometimes practically absent. Such a radiographic picture resembles Crohn's disease or ischemic stenosis. Functional small intestinal obstruction can also occur without a mechanical obstruction in the intestinal lumen due to a violation of its motor activity.
In enterocolitis, in addition to changes in the small intestine, radiologically detect changes in the colon, most often in its rectosigmoid section, which is often narrowed, straightened, some of its segments are devoid of haustra, which resembles chronic ulcerative or granulomatous colitis. In some cases, ulcers, fistulous passages into the pelvic organs, and fibrosis of its wall are noted in the colon.
Certain help in differential diagnostics of non-specific bowel diseases, radiation enteritis and enterocolitis is provided by mesenteric angiography and colonoscopy. Damage to arterioles with ischemic changes confirms the pathological process of radiation genesis. Colonoscopy allows to detect acute and chronic radiation damages of the mucous membrane of the colon. Depending on the stage of damage, edema, granularity, friability, pallor and dullness of the mucous membrane and injected submucous dilated vessels are detected. Diagnostics is aided by tests for absorption of various substances, study of parietal digestion, duodenojejunal contents and feces for dysbacteriosis, morphological examination of biopsy specimens of the mucous membrane of the small and large intestine.
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