PMC6349605_01
Axial view of computed tomography scan of the abdomen before chemoradiation therapy. Pancreatic tumor abutted but did not encase the hepatic artery, portal splenic confluence, or superior mesenteric artery.
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The mass abutted but did not encase the hepatic artery, portal splenic confluence, or superior mesenteric artery (Fig 1).
Radiation treatment plan (planned for a total dose of 55 Gy in 25 fractions with concurrent 5-flourouracil). (A) Axial slice showing radiation dose overlapping the transverse colon. (B) Coronal image of radiation plan. Large areas of overlap between treatment planning target volume and large bowel.
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The patient started 5-FU-based CRT with the plan for a total dose of 55 Gy in 25 fractions using a 6 MV volumetric modulated arc therapy plan (Fig 2).
Coronal view from computed tomography scan of the abdomen after radiation therapy. Note pancolonic wall thickening with adjacent inflammatory changes compatible with an acute inflammatory colitis.
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During his hospitalization a CT of the abdomen and pelvis showed pancolonic wall thickening with adjacent inflammatory changes (Fig 3).
Colonoscopy showing mucosa with punctate hemorrhages, ulceration, and increased friability with contact.
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The mucosa had punctate hemorrhages and ulceration and was friable with contact (Fig 4).