RADIATION INJURY TO THE RECTUM AND SIGMOID COLON

Bowel damage following x-ray and radium therapy of cervical carcinoma are described. Symptoms of abdominal pain, tenesmus, and the passage of blood from the rectum are typical signs of injury although the character of the symptoms vary with the type and extent of intestinal pathologic condition. Stages of pathology are classified. In general, acute proctitis (stage 1) usually subsides spontaneously or responds to a bland or low residue diet, sedation, antispasmodics, and intestinal antlbiotics. Similar treatment is recommended for ulceration with proctitis (stage 2), but during this treatment the patient must be under careful observation because of the possibility of complications of severe bleeding, intestinal obstruction, or perforation of the bowel, which usually require surgery. Irradiation necrosis of the bowel is influenced by mechanical factors, such as positioning of radium applicators, position of the uterine fundus, normal anatomic proximity of the rectum to the cervix, and the presence of adhesions holding small or large bowel in a constant position within radiation range. All contribute toward possible irradiation overdosage to the intestine and particularly the rectum and sigmoid colon. (P.C.H.)