Management of colitis caused by irradiation

Radiation therapy has assumed a role of primary importance in the management of gynecologic and other malignant growths. To be effective, the treatment dosage must be adequate. However, with higher dosages for curative radiation therapy, damage from the treatment may promote prolonged morbidity and even death. The effects of this treatment may be intensified by predisposing conditions within the patient, but the damage seems to be related to the insertion of radium. Prior to therapy, each patient must be individualized, and any predisposing factors should be kept in mind during treatment to recognize and treat these complications early. Once complications have arisen, the most conservative modality of dealing with the irradiated tissue is best, since these areas of intestinal injury do not heal. This requires early diversion or resection as conservative therapy, because fistulas and bleeding will become recurrent and intractable. If diversion fails to control bleeding, resection is necessary, even if it involves an abdominoperineal resection. Therefore, conservative can become radical for this supposedly benign illness.