What are the key symptoms and signs of radiation enteritis that I should look for in patients with a history of pelvic radiotherapy?

Key symptoms and signs of radiation enteritis in patients with a history of pelvic radiotherapy include:

• Chronic diarrhoea, often with urgency and sometimes incontinence, reflecting mucosal damage and malabsorption.
• Abdominal pain and cramping, which may be intermittent or persistent due to inflammation and fibrosis of the bowel wall.
• Rectal bleeding or passage of mucus, indicating mucosal ulceration or telangiectasia.
• Weight loss and nutritional deficiencies, secondary to malabsorption and chronic inflammation.
• Signs of bowel obstruction such as nausea, vomiting, abdominal distension, and altered bowel habits, due to strictures or fibrosis.
• Systemic features like fatigue may be present due to chronic disease and malnutrition.

On clinical examination, findings may be non-specific but can include abdominal tenderness, signs of dehydration, and in severe cases, palpable masses or distension if obstruction is present.

These manifestations typically arise months to years after pelvic radiotherapy and reflect both acute mucosal injury and chronic fibrotic changes in the bowel wall and mesentery ¹ (Bismar and Sinicrope, 2002; Harb et al., 2014; Loge et al., 2020).