Radiation proctitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rekha, M.D., Mahshid Mir, M.D. [2]

Overview

Radiation proctitis must be differentiated from infectious colitis,inflammatory bowel disease,ischemic colitis,medication-associated colitis,chemical colitis and allergic colitis

Differentiating Radiation proctitis from other Diseases

The following conditions may present in a similar manner as radiation proctitis, and should be excluded:[1]

The table below lists the differential diagnosis of common causes of colitis:

Diseases History and Symptoms Physical Examination Laboratory findings
Diarrhea Rectal bleeding Abdominal pain Radiation exposure Atopy Dehydration Fever Hypotension Malnutrition Blood in stool (frank or occult) Microorganism in stool Imaging Pseudomembranes on endoscopy
Allergic Colitis + ++ + - ++ - - - - ++ - - -
Chemical colitis + ++ ++ - - + + - - ++ - - +
Infectious colitis ++ ++ ++ - - +++ +++ ++ + ++ ++ CT shows bowel wall thickening and edema +
Radiation proctitis + ++ + ++ - + - - + ++ - - -
Ischemic colitis + + ++ - - + + + + ++ - Abdomen xray shows distention and pneumonitis

CT scan suggestive of double halo appearance and thumb printing sign

-
Inflammatory bowel disease ++ ++ Diffuse + - - +/- +/- - + ++ - String sign on abdominal xray in Crohn's -
Medication induced colitis + + ++ - - - + - - ++ - - +

References

  1. Babb RR (1996). "Radiation proctitis: a review". Am J Gastroenterol. 91 (7): 1309–11. PMID 8677984.

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