Chronic Diarrhea & Vomiting in a Cancer Survivor

🔵 Clinical Case Quiz

History

• 57-year-old woman
• Cramping abdominal pain
• Episodic vomiting and diarrhea for 1 month
• Unresponsive to symptomatic treatment and antibiotics
• History of endometrial carcinoma
• Total abdominal hysterectomy and radiotherapy 10 months ago
• Regular follow-up confirmed complete remission

Examination

• BP: 100/70 mmHg
• Pulse: 88 bpm
• Temperature: 97.8°F
• Abdominal examination unremarkable

Investigation

• CBC
• Serum electrolytes
• Stool examination
• Abdominal CT scan
• Assessment for radiation-induced bowel disease

❓ Question

A 57-year-old woman develops recurrent abdominal cramps, vomiting, and diarrhea 10 months after pelvic radiotherapy for endometrial carcinoma. What is the most likely diagnosis?

A. Irritable bowel syndrome
B. Infectious gastroenteritis
C. Chronic radiation enteritis
D. Recurrent endometrial carcinoma

✅ Answer: Chronic Radiation Enteritis

Answer Explanation

Chronic radiation enteritis is a late complication of pelvic radiotherapy, typically occurring months to years after treatment. Symptoms include abdominal pain, diarrhea, nausea, vomiting, malabsorption, and intermittent bowel obstruction. The temporal relationship with radiotherapy strongly supports the diagnosis.

Why Not Others?

A. Irritable Bowel Syndrome
Functional disorder not related to prior radiotherapy.

B. Infectious Gastroenteritis
Usually acute and often self-limiting or responsive to treatment.

D. Recurrent Endometrial Carcinoma
Follow-up showed remission and symptoms are more typical of radiation injury.

💎 Clinical Pearls

• Can occur months to years after radiotherapy.
• Small bowel is highly radiosensitive.
• Chronic diarrhea is common.
• May cause malabsorption and weight loss.
• Can lead to strictures and obstruction.
• CT enterography helps diagnosis.
• May mimic cancer recurrence.
• Prior pelvic radiotherapy is an important clue.
• Nutritional support is often required.
• Surgery may be needed for severe complications.

❓ Frequently Asked Questions (FAQ)

1. What is chronic radiation enteritis?
Late bowel damage caused by radiotherapy.

2. When does it occur?
Usually months to years after treatment.

3. Which organ is most affected?
The small intestine.

4. What is the commonest symptom?
Chronic or recurrent diarrhea.

5. Can abdominal pain occur?
Yes, cramping abdominal pain is common.

6. Can it cause bowel obstruction?
Yes, due to fibrosis and strictures.

7. How is it diagnosed?
Clinical history plus imaging studies.

8. Can it mimic cancer recurrence?
Yes, symptoms may be similar.

9. What is the main treatment?
Supportive care and nutritional management.

10. When is surgery needed?
For obstruction, fistula, or severe disease.

Chronic radiation enteritis, Radiation bowel disease, Pelvic radiotherapy complications, Endometrial carcinoma, Chronic diarrhea diagnosis, Radiation-induced bowel injury, Post-radiotherapy abdominal pain, Gastrointestinal radiation toxicity, Internal medicine quiz, Clinical case challenge

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Tags: Gastroenterology