Pediatric Radiation Induced Enteritis

  • Etiology:
    — Acutely: Toxic effects of radiotherapy on bowel wall lead to inflammation and ulceration of bowel wall mucosa and submucosa
    — Chronically: Healing and fibrosis occurs
  • Imaging Acute: Bowel loops have luminal narrowing and edema of mucosal folds
  • Imaging Chronic:
    — Thickening of bowel wall and folds due to fibrosis
    — Stack of coins sign of enlarged and smooth and parallel mucosal folds
    — Stenoses in the bowel
  • DDX: Mesenteric ischemia
  • Complications: Toxic effects of radiotherapy on bowel vasculature can cause endarteritis obliterans resulting in chronic mesenteric ischemia causing bowel strictures leading to small bowel obstruction
  • Treatment:
  • Clinical:

Radiology Cases of Radiation Induced Enteritis

Radiology Cases of Acute Radiation Induced Enteritis of the Small Bowel

Small bowel follow through of acute radiation enteritis
AP image from a small bowel follow through exam shows diffuse luminal narrowing of the distal jejunum and proximal ileum in the center of the image.

Radiology Cases of Chronic Radiation Induced Enteritis of the Small Bowel

Small bowel follow through of chronic intestinal ischemia
AP image from an upper GI and small bowel follow through exam shows marked thickening of the small bowel folds throughout the jejunum (stack of coins sign).
UGI and SBFT of radiation induced enteritis
AP image from an upper GI and small bowel follow through exam shows mild thickening of the small bowel folds throughout the jejunum (stack of coins sign).

Radiology Cases of Chronic Radiation Induced Enteritis of the Colon

Barium enema of radiation induced enteritis of colon
AP image from an enema shows a fixed narrowing of the descending colon from the splenic flexure to the sigmoid colon with dilation of the colon proximal to it. The extremely dilated cecum is in the midline of the pelvis.