A 77-year-old woman underwent adnexectomy for right ovarian cancer six years ago. As the recurrence of the cancer in the left supraclavicular and right paraaortic lymph nodes was detected by computed tomography, she received intensity modulated radiation therapy for both lymph nodes. After three months of radiotherapy she complained of tarry stools and shortness of breath, and she was referred to our hospital. Frequent erythrocyte transfusions had been received due to the continuous tarry stools and severe anemia. Upper gastrointestinal endoscopy showed friable mucosa with telangiectasias in the descending and horizontal part of the duodenum. A diagnosis of radiation-induced hemorrhagic duodenitis was made, then argon plasma coagulation (APC) was performed consecutively. The tarry stools ceased after the second APC treatment. Her hemoglobin level was sustained more than 9 g/dL after the sixth APC treatment without further blood transfusions.
APC is effective in the management of radiation-induced hemorrhagic duodenitis. On the occasion of the APC treatment a skill seems required because the duodenal lumen is not wide and spasms occur strongly during ablation.
