Presentation
Cervical cancer (operated) and recent radiotherapy complaining of severe abdominal pain and recent ultrasound revealed a right hydronephrosis and hydroureter.
Patient Data
Evidence of hysterectomy with unremarkable vaginal stump
Visualized pelvic bowel loops mainly distal, terminal ileum and cecum with lesser extension to the rectum and sigmoid colon are showing long segment of diffuse and circumferential mural wall thickening, luminal narrowing and surrounded with smudging fat planes in between the pelvic bowel loops suggestive of an inflammatory process could be radiation enteritis for clinical correlation.
No evidence of localized collections or free gas.
Mild to moderate resolving previously noted mural thickening of the pelvic bowel loops
Near complete resolution of the earlier documented inflammatory changes in the bowel.
Case Discussion
The patient was treated with radiation as an adjuvant therapy for cervical cancer after an operation and developed acute abdominal pain and elevated renal function tests. Radiological findings as mentioned above were suggestive of acute radiation enteritis and pelvic radiotherapy was not completed.
A follow-up 5 months after cessation of radiation therapy showing near complete resolution of the earlier documented inflammatory changes in the bowel. Mild residual hydroureteronephrosis on right side.
In this clinical setting, the appearances are consistent with radiation enteritis.
Top differential diagnoses include:
Crohn disease
metastases/lymphoma
ischemic enteritis.
primary bowel tumor
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