Images in Clinical Medicine
Diffuse Chemoradiotherapy-Related Enterocolitis
N Engl J Med 2007; 356:2514June 14, 2007
- Article
An 86-year-old man received a diagnosis of stage IV adenocarcinoma of the rectum, with metastatic disease noted below the aortic bifurcation. He had no history of inflammatory bowel disease. He was treated with 4500 cGy of radiation delivered to the whole pelvis in 25 fractions by means of a four-field box technique, in conjunction with fluorouracil and folic acid. Five weeks after the initiation of the radiotherapy, severe diarrhea developed, increasing to 11 episodes per day. No infectious pathogens were found. Computed tomography of the abdomen showed diffuse bowel changes that involved most of the ileum (Panels A and B, thin arrows) and the ascending colon (Panel A, thick arrow). Diffuse chemoradiotherapy-related enterocolitis was diagnosed. The patient was hospitalized to receive supportive care but died 1 month later because of secondary infection and massive bleeding from a stress ulcer.
Hon-Yi Lin, M.D.
Yee-Min Jen, M.D., Ph.D.
Tri-Service General Hospital, Taipei 114, Taiwan
doc31221@ndmctsgh.edu. tw
