Complications of chemotherapy are wide ranging and relatively common. We wished to compile a short review of the main manifestations of Hepatic and GI tract complications secondary to chemotherapy. We also present the salientcomputed tomographyfindings of three patients who recently presented to our department.

Intestinal enteropathy - symptoms and signs Can occur at any stage in the chemotherapy regimen (1)Presenting symptoms:Profuse watery diarrhoea Acute abdominal pain and fever Clinical findings:Abdominal tenderness PeritonismLaboratory findings:Features of sepsisRisk FactorsHaematological malignancies (2)Germ cell tumours (3)Gastro-intestinal cancer chemotherapy - eg: Cisplatin, 5-FU, Vincristine, BevacizumabLong term immunosuppressive treatment - particularly for graft versus host disease (2)Mechanisms:Direct mucosal injury:Abnormal gut flora proliferate secondary to breakdown of the normal local immune response, which impairs healing. This allows penetration of bacteria through defects in the mucosa, leading tothe...

Intestinal enteropathy (CT)Caecal disease is typically described separately as typhlitis but any part of the bowel can be affected (1)Dilated non-obstructed bowel Non-specific diffuse or focal bowel wall thickening which may abnormally enhance(4) Target sign may be presentRegional vascular engorgement and mesenteric haziness. Vascular thrombosis(8) Patients on Bevacizumab are at increased risk of intestinal perforation(9) Hepatic VOD (CT)Ascites Hepatomegaly Gall-bladder wall thickening Peri-portal oedema Narrowed hepatic veins Peripheral mosaic-like enhancement may occur (10)

EnteropathyTreatment and outcomesSuccessful treatment depends on early diagnosis Mortality: ~21-48% (3) Immediate surgical intervention is not always indicated as shown in case 2. Resolution can occur spontaneously following cessation of chemotherapy No specific therapy has any significant evidence-base Indications for surgery: Ischaemic bowel, persistent intestinal haemorrhage, perforation (1)Hepatic VODTreatment and outcomesTreament is largely supportive: analgesia, diureticsMortality approaches 100% and depends on severity of disease (11)

1. Cronin C. et al, Imaging of the gastrointestinal complications of systemic chemotherapy, Clinical Radiology Volume 64, Issue 7, July 2009, Pages 724-7332. Coy, DL, et al. Imaging Evaluation of Pulmonary and Abdominal Complications Following Hematopoietic Stem Cell Transplantation. RadioGraphics 2005; 25:305–3183. Ei-Ichiro Takaoka, Koji Kawai, Satoshi Ando, Toru Shimazui, and Hideyuki AkazaNeutropenic Colitis during Standard Dose Combination Chemotherapy with Nedaplatin and Irinotecan for Testicular CancerJapanese Journal of Clinical Oncology Advance Access published on January 25, 2006;36(1)60–634. M.P. Frick, C.W. Maile and J.R. Crass et...