Vásquez Luis, Guevara Julissa, Aguilar Victor, Menéndez Monica, Bravo Eduar, Guzman Rojas Patricia, Pichilingue Catherina, Zegarra Arturo, Huerta-Mercado Jorge, Pinto José, Prochazka Ricardo, Valenzuela Vanessa, Bussalleu Alejandro
Hospital Nacional Cayetano Heredia. Lima, Perú.
Hospital Nacional Cayetano Heredia. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú.
Rev Gastroenterol Peru. 2016 Apr-Jun;36(2):159-63.
Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year- old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleeding’s source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB.
慢性光化性肠炎是小肠的一种功能障碍，发生在放疗后的6个月内，可表现为吸收不良、狭窄、瘘管形成、局部脓肿、穿孔和出血。我们报告一例老年患者，因光化性肠炎继发隐匿性胃肠道出血（OGIB）。她是一名64岁的女性患者，有宫颈癌病史，接受过放疗和近距离放疗。治疗一年后，患者出现慢性黑便和症状性贫血，入院前1周出现便血。入院时她有血流动力学不稳定，血红蛋白值为2.7克/分升。我们进行了上消化道内镜检查、结肠镜检查和腹盆腔断层扫描，未发现出血源。因此进行了内镜胶囊检查，显示小肠中远端有出血区域。患者再次出现胃肠道出血，需要进行手术，决定切除小肠并进行右半结肠切除术。病理结果与光化性肠炎相符。患者术后恢复缓慢，最终死亡。我们描述了这个病例，并对世界各地所有现有数据进行了综述，因为这是秘鲁首例报告的光化性肠炎导致OGIB的病例。
