SHM Converge Scientific Abstract ePoster Gallery-Acute Abdomen, Baffled Bowels: A Fulminant Presentation of Radiation Enterocolitis

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This case describes an 82-year-old man with progressive abdominal pain, anorexia, and constipation that began one week after completing abdominopelvic radiotherapy for recurrent bladder cancer. He had previously undergone radical cystectomy with ileal conduit diversion and was taking oxycodone, which likely contributed to bowel dysfunction and may have obscured the usual diarrheal presentation of radiation enterocolitis.<br /><br />On exam, he had a distended, silent abdomen with diffuse rebound tenderness, suggesting peritonitis. Laboratory studies and infectious stool testing were unrevealing. CT imaging showed diffuse bowel wall thickening, colonic dilation, mesenteric fat stranding, vascular engorgement, and liquefied stool without mechanical obstruction—findings consistent with severe enterocolitis. He was treated supportively with empiric antibiotics and reduced opioids. Although bowel function returned with diarrhea, abdominal tenderness persisted. Endoscopic evaluation was limited because the affected small bowel could not be reached and colonoscopy was deferred due to risk and poor preparation.<br /><br />His course was later complicated by Candida albicans fungemia, and he died on hospital day 27.<br /><br />The presentation highlights radiation enterocolitis as an important, sometimes severe complication of abdominopelvic radiation. It results from ionizing injury to the gut with mucosal disruption, inflammation, and occlusive vasculitis. Acute toxicity commonly develops at cumulative doses of 10–20 Gy, and many patients receiving pelvic radiation develop some degree of enteritis. Typical symptoms include diarrhea, abdominal pain, tenesmus, and hematochezia, but severe cases may present atypically. Treatment is largely supportive, and there is no specific therapy that reliably hastens recovery.<br /><br />Key lessons are to consider radiation injury in the differential diagnosis of enterocolitis, obtain a careful oncologic treatment history, and remember that opioid-induced constipation can mask classic GI symptoms.

Asset Subtitle

Nathaniel P. Giles

Meta Tag

Author List Mario Suito Ferrand, Nathaniel P. Giles, Zaven Sargsyan

Category Clinical Vignettes

Concept Radiation Enterocolitis

Concept Bowel Wall Thickening

Concept Supportive Care

Concept Abdominopelvic Radiotherapy

Concept Enterocolitis

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Nathaniel P. Giles

Track Adult

Keywords

radiation enterocolitis

abdominopelvic radiotherapy

bladder cancer

opioid-induced constipation

abdominal pain

peritonitis

computed tomography

bowel wall thickening

Candida albicans fungemia

supportive treatment

Radiation Enterocolitis

Bowel Wall Thickening

Supportive Care

Abdominopelvic Radiotherapy

Enterocolitis