Radiation-Induced Enteritis

A 71-year-old man was admitted to the hospital with persistent hematochezia during the past 6 months. He was diagnosed with stage IV prostate cancer and treated with chemotherapy and radiation 1 year before presentation. A tagged red blood cell scan completed previously suggested a source in the distal small bowel or proximal colon. Gastroenterology was consulted and elected to pursue capsule endoscopy. Capsule images revealed radiation-induced enteritis affecting the majority of the small bowel (Figures A and B) characterized by superficial serpentine vessels larger than arteriovenous malformation disease. Biopsies taken during push enteroscopy showed small bowel mucosa with dilated ectatic hyalinized capillaries in the lamina propria and reactive changes (Figures C and D, yellow arrows). Unfortunately, because of the extent of the disease, treatment was extremely limited. Bleeding resolved after initiation of subcutaneous octreotide and sucralfate. He was also treated supportively with blood and iron transfusions. Hyperbaric oxygen therapy was not pursued because of patient transportation issues. Radiation-induced enteritis images of this quality are uncommon. Capsule endoscopy can be a reliable method in making this diagnosis.