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Small bowel (small intestine)

Inflammatory disorders

Radiation enterocolitis


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 15 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Observed acutely or years after radiation therapy for cervical carcinoma, Wilm’s tumor, lymphoma or other peritoneal tumors

Clinical features
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● Acute: anorexia, cramps, diarrhea due to mucosal injury and malabsorption
● Chronic: may present as inflammatory colitis or indolent; also vascular injury, ischemic fibrosis, stricture
● Treatment: resection if severe

Gross description
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● Thickened bowel wall

Micro description
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Acute:
● Varies from mild epithelial damage to massive necrosis and ulceration (BMC Surg 2004;4:10)
● Loss of columnar shape and nuclear polarity of enterocytes, nuclear pyknosis, bizarre nuclei, mucin depletion and decreased mitoses
● Also fibroblasts and endothelium with submucosal edema but low nuclear to cytoplasmic ratio, preservation of architecture
● No desmoplasia, no infiltrative pattern

Chronic:
● Atrophic and ulcerated mucosa, ectatic blood vessels, fibrosis of submucosa and muscular wall, vascular wall thickening, vascular stenosis
● Possible fistula formation, atherosclerosis-like changes of vasculature (subintimal lipid-laden macrophages, calcification, thrombosis), hyalinization of lamina propria

Micro images
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Acute changes (mice)

End of Small bowel (small intestine) > Inflammatory disorders > Radiation enterocolitis


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