Presentation
A case of cancer cervix (operated) and on recent radiotherapy complaining of severe abdominal pain and recent ultrasound revealed a right hydronephrosis and hydroureter.
Patient Data
Evidence of hysterectomy with unremarkable vaginal stump
The visualized pelvic bowel loops mainly distal, terminal ileum and cecum with lesser extension to the rectum and sigmoid colon are showing long segment of diffuse and circumferential mural wall thickening, luminal narrowing and surrounded with smudging fat planes in between the pelvic bowel loops suggestive of an inflammatory process could be radiation enteritis for clinical correlation.
No evidence of localized collections or free air.
Mild to moderate resolving previously noted mural thickening of the pelvic bowel loops
and rectum with a minimal standing of the surrounding mesenteric fat noted, finding
possibly representing post therapy/operative changes.
Tortuous right ureter down to the pelvic prime where it can be seen narrowed at the certain segment, yet the contrast media can be seen within the right ureter giving urine contrast
level and also can be traced down to the urinary bladder. No stone or obvious mass seen.
Near complete resolution of the earlier documented inflammatory changes in the bowel.
Mild residual hydroureteronephrosis on right side.
Case Discussion
The patient was treated with radiation as an adjuvant therapy for cervical cancer after an operation and developed acute abdominal pain and elevated renal function tests. Radiological findings as mentioned above were suggestive of acute radiation enteritis and pelvic radiotherapy was not completed.
A follow-up 5 months after cessation of radiation therapy showing near complete resolution of the earlier documented inflammatory changes in the bowel. Mild residual hydroureteronephrosis on right side.
In this clinical setting, the appearances are consistent with radiation enteritis.
Top differential diagnoses include:
- Crohn's disease
- metastases/lymphoma
- ischemic enteritis.
- primary bowel tumor
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