Abstract
Radiation-induced injury is a rare cause of gastrointestinal bleeding. We report a 70-year-old woman with recurrent hemorrhage from radiation-induced telangiectasias in the duodenum. She had undergone surgery for cholangiocarcinoma three years previously and received radiation therapy for recurrence in lymph nodes behind the uncinate process of the pancreas. Four months after the completion of radiation therapy, she was referred to our hospital because of the passage of tarry stools and severe anemia. Upper gastrointestinal endoscopy showed edematous and friable mucosa with multiple telangiectasias in the bulbs and descending part of the duodenum. There was active bleeding from the telangiectasias. We attempted to treat the telangiectasias in the descending part of the duodenum by argon plasma coagulation (APC). However, APC and empirical treatment with mucosal protectants were unsuccessful. Therefore, we administered octreotide, an analogue of somatostatin. After the administration of octreotide, the tarry stools stopped and the APC therapy and red blood cell transfusion were no longer necessary. The drug was well tolerated and there were no serious adverse events. No recurrence of bleeding from radiation-induced duodenitis has occurred over the following two months. We suggest that administration of octreotide in combination with APC is beneficial for the treatment of patients with refractory radiation-induced hemorrhagic duodenitis. To the best of our knowledge, this is the first report of the use of octreotide for the treatment of radiation-induced hemorrhagic duodenitis.
