Hemorrhagic radiation gastritis after chemoradiation therapy for peritoneal lymph node metastasis of esophageal carcinoma successfully treated with repeated intraarterial steroid infusions |
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Authors: | Kazuki Inaba Yoichi Sakurai Shinpei Furuta Risaburo Sunagawa Shuhei Tonomura Yasuko Nakamura Jun Isogaki Ichiro Uyama Yoshiyuki Komori Ryoichi Kato Tatsuo Banno |
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Institution: | (1) Department of Surgery and Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan |
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Abstract: | Although intraarterial steroid infusion therapy has previously been shown to be effective for inflammatory bowel disease,
it has not yet been applied for the treatment of hemorrhagic radiation gastritis. We report herein a case of hemorrhagic radiation
gastritis of gastric tube that occurred after chemoradiation therapy for postoperative peritoneal lymph node metastasis in
a patient with esophageal carcinoma who had a history of esophagectomy reconstructed with a gastric tube. The hemorrhagic
gastritis that occurred in the gastric tube was successfully treated with repeated intraarterial steroid infusions through
the regional vessels to the reconstructed gastric tube. A 70-year-old Japanese woman received chemoradiation therapy for metastatic
lymph nodes of the celiac axis. Four weeks after completion of chemoradiation therapy, acute persistent bleeding occurred
in the gastric mucosa of the reconstructed gastric tube in the irradiated area. Despite application of available therapeutic
modalities, her persistent bleeding was intractable, and a total of 50 units of blood transfusion was required to improve
progressive anemia. Finally, intraarterial steroid infusion therapy was applied through the right gastroepiploic artery supplying
the main blood flow to the gastric tube. Three repeated intraarterial steroid infusions through the right gastroepiploic artery
were effective, and hemostasis was finally completed soon after the last dose of intraarterial steroid was given. This case
highlights the clinical importance and significance of hemorrhagic radiation gastritis of the reconstructed gastric tube with
posterior mediastinal route occurring after chemoradiation therapy. Repeated intraarterial steroid infusion could be one option
that appears clinically useful to treat intractable bleeding from radiation gastritis. |
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Keywords: | Hemorrhagic radiation gastritis Intraarterial steroid infusion Esophageal carcinoma Gastric tube |
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