Radiation-induced jejunal mucosal vascular lesions as a cause of significant gastroinstestinal hemorrhage

Vascular‐enteric fistulas associated with radiation therapy in patients with pancreatic adenocarcinoma

“…Various reasons have been given for upper gastrointestinal haemorrhage related to radiotherapy of pancreatic adenocarcinoma [2–6]. Van Dam [7] found that it usually emanated from superficial capillaries and not from discrete or diffuse ulceration.…”

“…However, most radiation‐induced gastro‐intestinal haemorrhages are refractory and carry a poor prognosis. Endoscopic laser coagulation and bipolar electrocautery have provided temporary haemostasis in treatment of mucosal haemorrhages [3,4], but a high incidence of recurrent bleeding casts doubt on their long‐term efficacy [4]; these measures would have little or no role to play in controlling arterial haemorrhage of such magnitude. Severe bleeding should suggest the possibility of a vascular‐enteric fistula.…”