Advertisement

Diseases of the Colon & Rectum

, Volume 36, Issue 2, pp 135–138 | Cite as

A simple and effective treatment for hemorrhagic radiation proctitis using formalin

  • Francis Seow-Choen
  • Hak-Su Goh
  • Kong-Weng Eu
  • Yik-Hong Ho
  • Sun-Kuie Tay
Original Contributions
  • 81 Downloads

Abstract

Radiation proctitis is a common complication of radiotherapy for pelvic malignancy. In the more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. Medical therapy in patients with radiation proctitis is usually ineffective, whereas surgery is associated with a high morbidity and mortality. Eight patients (seven females and one male) with hemorrhagic radiation proctitis were Treated over a six-month period with endoluminal formalin. The technique used ensured minimal contact with formalin. The median age of the patients was 68 years (range, 42–73 years). Seven patients had had cancer of the uterine cervix, and one patient had had cancer of the prostate treated with radiotherapy at a median time of 30 months (range, 9–46 months) previously. The median duration of time of symptomatic rectal hemorrhage before formalin therapy was eight months (range, 1–12 months). The median number of units of blood transfused previously per patient was four (range, 2–32). The time taken for formalin therapy was 20 minutes (range, 10–70 minutes). One patient required repeat formalin application at two weeks. Bleeding ceased immediately in seven patients after formalin treatment. No further bleeding was noted, nor was any blood transfusion needed, at follow-up at four months (range, 1–6 months). Formalin therapy is a simple, inexpensive, and effective treatment for hemorrhagic radiation proctitis.

Key words

Radiation enteritis Rectal bleeding Formaldehyde 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fischer L, Kimose HH, Spjeldnaes N, Wara P. Late progress of radiation-induced proctitis. Acta Chir Scand 1990;156:801–5.PubMedGoogle Scholar
  2. 2.
    Jagelman DG, Rothenberger DA, Wexner SD. Irradiation injuries to the intestine. Perspect Colon Rectal Surg 1990;3:275–96.Google Scholar
  3. 3.
    Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN. The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med 1983;205:40–53.Google Scholar
  4. 4.
    Browning GG, Varma JS, Smith AN, Small WP, Duncan W. Late results of mucosal proctectomy and coloanal sleeve anastomosis for chronic irradiation rectal injury. Br J Surg 1987;74:31–4.PubMedGoogle Scholar
  5. 5.
    Hurtig A. Local hydrocortisone acetate for radiation proctitis. J Postgrad Med 1954;15:37–9.Google Scholar
  6. 6.
    Blank WA. Irradiation injury to the bowel and rectum. J R Soc Med (suppl) 1970;63:98–100.Google Scholar
  7. 7.
    Golstein F, Khoury J, Thorton JJ. Treatment of chronic radiation enteritis and colitis with salicylazopyridine and systemic corticosteroids. Am J Gastroenterol 1976;65:201–8.PubMedGoogle Scholar
  8. 8.
    McElligott E, Quigley C, Hanks GW. Tranexamic acid and rectal bleeding. Lancet 1988;2:1.PubMedGoogle Scholar
  9. 9.
    Kocker R, Sharma SL, Gupta BB, Mehta SK. Rectal sucralfate in radiation proctitis. Lancet 1988;2:400.Google Scholar
  10. 10.
    Baum CA, Biddle WL, Miner PB. Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis. Dig Dis Sci 1989;34:758–60.PubMedGoogle Scholar
  11. 11.
    Anseline PF, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Radiation injury of the rectum. Evaluation of surgical treatment. Ann Surg 1981;194:716–24.PubMedGoogle Scholar
  12. 12.
    Marks G, Mohiudden M. The surgical management of the radiation-injured intestine. Surg Clin North Am 1983;63:81–96.PubMedGoogle Scholar
  13. 13.
    Jao SW, Beart RW, Gunderson LL. Surgical treatment of radiation injuries of the colon and rectum. Am J Surg 1986;151:272–7.PubMedGoogle Scholar
  14. 14.
    Russell JC, Welch JP. Operative management of radiation injuries of the intestinal tract. Am J Surg 1979;137:433–42.PubMedGoogle Scholar
  15. 15.
    Allen-Mersh TG, Wilson EJ, Hope-Stone HF, Mann CV. The management of late radiation-induced rectal injury after treatment of carcinoma of the uterus. Surg Gynecol Obstet 1987;64:521–4.Google Scholar
  16. 16.
    Cunningham IG. The management of radiation proctitis. Aust N Z J Surg 1980;50:172–8.PubMedGoogle Scholar
  17. 17.
    O'Conner JJ. Argon laser treatment of radiation proctitis. Arch Surg 1989;124:749.PubMedGoogle Scholar
  18. 18.
    Lucarotti ME, Mountford RA, Bartolo DC. Surgical management of intestinal radiation injury. Dis Colon Rectum 1991;34:865–9.PubMedGoogle Scholar
  19. 19.
    Alexander TJ, Dwyer RM. Endoscopic Nd:YAG laser treatment of severe radiation injury of the lower gastrointestinal tract: long term follow-up. Gastrointest Endosc 1988;34:407–11.PubMedGoogle Scholar
  20. 20.
    Buchi KN, Dixon JA. Argon laser treatment of hemorrhagic radiation proctitis. Gastrointest Endosc 1987;33:27–30.PubMedGoogle Scholar
  21. 21.
    Donahue LA, Frank IN. Intravesical formalin for hemorrhagic cystitis: analysis of therapy. J Urol 1989;141:809–12.PubMedGoogle Scholar
  22. 22.
    Rubinstein E, Ibsen T, Rasmussen RB, Reimer E, Sorensen BL. Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol 1986;81:44–5.PubMedGoogle Scholar
  23. 23.
    Galland RB, Spencer J. Natural history and surgical management of radiation enteritis. Br J Surg 1987;74:742–7.PubMedGoogle Scholar
  24. 24.
    Galland RB, Spencer J. Surgical aspects of radiation injury to the intestine. Br J Surg 1979;66:135–8.PubMedGoogle Scholar
  25. 25.
    Schofield PF, Carr ND, Holden D. Pathogenesis and treatment of radiation bowel disease: discussion paper. J R Soc Med 1986;79:30–2.PubMedGoogle Scholar
  26. 26.
    Stuart M, Failes DG, Killingback MJ, Deluca C. Irradiation injuries of the large intestine. Dis Colon Rectum 1980;23:94–7.PubMedGoogle Scholar
  27. 27.
    Cochrane JP, Yarnold JR, Slack WW. The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma. Br J Surg 1981;68:25–8.PubMedGoogle Scholar
  28. 28.
    Decosse JJ, Rhodes RS, Wentz WB, Reagan JW, Dworken HJ, Holden WD. The natural history and management of radiation induced injury of the gastrointestinal tract. Ann Surg 1969, 170:369–84.PubMedGoogle Scholar
  29. 29.
    Brown RB. A method of management of inoperable carcinoma of the bladder. Med J Aust 1969;1:23–4.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Francis Seow-Choen
    • 1
  • Hak-Su Goh
    • 1
  • Kong-Weng Eu
    • 1
  • Yik-Hong Ho
    • 1
  • Sun-Kuie Tay
    • 2
  1. 1.Department of Colorectal SurgerySingapore General HospitalSingaporeSingapore
  2. 2.Departments of Obstetrics and GynaecologySingapore General HospitalSingaporeSingapore

Personalised recommendations