Small bowel radiation enteritis diagnosed by capsule endoscopy.

To cite: Schembri J, Azzopardi M, Ellul P. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202552 DESCRIPTION Our patient is a middle-aged woman who had been diagnosed with uterine leiomyosarcoma for which she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. She received adjuvant radiotherapy which was delivered over a period of 4 weeks and which involved 20 fractions of 225cGy each for a total of 4500cGy, followed by a further two courses of pelvic radiotherapy in view of local recurrence. She presented to us with severe transfusiondependent anaemia associated with loose stools and abdominal pain 1 year after initial surgery. Abdominal CT and oesophagogastroduodenoscopy were normal and a colonoscopy revealed large stains with fresh blood and small clots on normal mucosa in the caecum and ascending colon. Since the impression was that the source of bleeding was from the small intestine the patient was thus scheduled to have video capsule endoscopy (VCE) after ensuring that there was no retention of the patency capsule. VCE revealed patches of mucosal atrophy and villous oedema (figure 1), stricturing (figure 2) as well as diffuse bleeding from the terminal ileum (figure 3). The gastrointestinal epithelium has a high proliferation rate, which makes it susceptible to damage by radiotherapy more than surrounding tissues. Radiation enteritis can be both acute and chronic, the latter typically developing 8–12 months after radiation exposure secondary to an obliterative arteritis. The small bowel becomes thickened with obstruction of lymphatics which results in mucosal and villous oedema. Intestinal mucosa becomes atrophied and bleeding can result from telangiectasias or from mucosal ulcerations. The latter will heal by fibrosis and lead to narrowing of the lumen and stricture formation. 2 All these findings were present in our patient and together with the history of radiation exposure the diagnosis of chronic radiation enteritis was made. To date published experience with regard to the use of VCE in small bowel enteritis is mainly anecdotal. The largest study, which involved 15 patients, concluded that VCE can safely and effectively diagnose small intestinal radiation enteritis