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The outstanding early symptom of radiation injury of the intestine is diarrhea, mild to severe in degree. Later manifestations are pain, demonstrable ulceration and stricture formation with partial or complete obstruction. The early lesions, located usually on the anterior wall of the rectum and rectosigmoid, are characterized by an edematous friable mucous membrane. Later ulceration, with a grayish white slough, occurs at the level of the cervix. In time perirectal fibrosis resembling a "frozen" pelvis may develop and result in obstruction. In the severe injuries with stenosis, hemorrhage or persistent severe pain, temporary or permanent colostomy may be required with or without resection of the bowel. Intractable pain may be treated by colostomy and resection of the afferent nerve supply to the rectum. The ideal therapy is, of course, prophylactic, the avoidance of radiation injury. Whether or not it is possible by attention to the details of technic to administer effective carcinocidal doses of irradiation without occasional severe injury to adjacent normal tissue such as the rectum seems questionable at present.

Excerpt INTRODUCTION In 1910 Schwartz1enunciated the dictum "no acid—no ulcer" the validity of which has been challenged repeatedly throughout the years. The purpose of this paper is to present a f...