Radiation Enteritis in the Patient with a Fecal Ostomy
October 10, 2007
Your patient presents with a history of ovarian carcinoma, 2 years post pelvic exenteration, chemotherapy, and pelvic radiation therapy. She has a colostomy and an ileal conduit. She now is experiencing extremely high output from her colostomy, symptoms of dehydration, frequent leakage and skin irritation, and a short wear time of 24 to 48 hours for her colostomy pouching system. After her physician and ostomy clinician make a thorough assessment, the diagnosis is radiation enteritis.
The National Cancer Institute1 defines radiation enteritis as, “inflammation of the small intestine caused by radiation therapy to the abdomen, pelvis, or rectum.” The linings of both the large and small bowel are particularly sensitive to radiation. Because radiation attacks rapidly dividing cells such as the normal cells lining the intestines, healing the bowel after radiotherapy becomes difficult. As these cells die, they are not replaced and the walls of the bowel become swollen and inflamed, causing gastrointestinal symptoms. The amount of damage to normal bowel tissue is related to the dose of radiation: the larger the dose, the greater the damage. Because tumors in the abdomen and pelvis usually require large doses of radiation,2 nearly all patients receiving radiotherapy in these anatomical locations experience some form of radiation enteritis.
Acute or Chronic?
It is important to note that radiation enteritis can be acute (symptoms appearing during the first course of treatment and up to 8 weeks later) and/or chronic (symptoms appear months or even years after completion of radiation treatments).2 According to the National Cancer Institute,2 5% to 15% of patients who undergo radiation therapy to the abdomen, pelvis, or abdomen will develop the chronic form of radiation enteritis. Symptoms of both acute and chronic radiation enteritis include nausea, vomiting, abdominal pain and cramping, frequent bowel movements, watery or bloody diarrhea, fatty stools, and weight loss.2 The timing of the emergence of the symptoms and/or their duration is a factor in determining acute or chronic enteritis. However, before making a diagnosis of chronic radiation enteritis, the presence of recurrent tumors must be ruled out.
The patient assessment should include the following information2:
• The amount of normal bowel treated
• The dose of radiation given
