Irradiation injury to the colon

EDITORIAL SYNOPSIS Two patients with irradiation injury to the colon are reported to illustrate the problem of diagnosis. There may be a long interval between irradiation and the onset of symptoms. Obstruction is common and is due to nerve and muscle damage impeding bowel motility. The treatment of cancer by irradiation always results in some damage to normal tissues, and damage to the bowel in the course of irradiation to the abdomen has been recognized for many years. Most reports, however, are of injury to the small intestine or rectum. This paper concerns two cases in which the colon alone was injured. CASE REPORTS CASE 1 This patient was a 45-year-old man. In March 1962 a left nephrectomy was performed for a papillary adenocarcinoma of the kidney. One month later a course _M FIG. 1. Results of a barium enema showing a stricture of the descending colon. of Cobalt 60 was given in two parallel opposed fields (15 cm. x 15 cm.), which included the kidney bed and regional lymphatics. A dose of 300 r was given daily alternating between the anterior and posterior portal. A total dose of 5,500 r was delivered over 29 days. The patient remained at work until May 1963 (month 12 from the time of irradiation) when he experienced an episode of severe epigastric pain and nausea. This settled down without treatment but one month later he was admitted to hospital following a week of obstinate constipation, lower abdominal pain, and distension. This too resolved over the following seven days, although a barium enema showed a stricture of the descending colon (Fig. 1). FIG. 2. Inflamed and thickened area in the descending colon found at operation