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Proktologische Erkrankungen bei onkologischen Patienten

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Zusammenfassung

Proktologische Beschwerden onkologischer Patienten entstehen meist durch tumor- und therapiebedingte Obstipation und Diarrhö. Hämorrhoiden, Analfissuren und Perianalthrombosen lassen sich in der Regel konservativ behandeln, können aber im Stadium der Tumorremission auch operiert werden. Während einer Chemotherapie auftretende infektiöse Komplikationen sollten vor Beginn einer immunsuppressiven Therapie oder im Intervall saniert werden, nicht in einer Aplasie. Eine enge Zusammenarbeit zwischen Onkologen und Proktologen ist notwendig. Unter immunsuppressiver Therapie treten auch Infektionen im Analbereich (z. B. Herpes-simplex-, Zytomegalievirusinfektion, Pyodermia fistulans, Fisteln, Abszesse) sowie unspezifische Infiltrate auf. Sie können bei ausgeprägter Neutropenie klinisch atypisch ablaufen. Eine Radiatio im Beckenbereich kann zur Proktitis, Diarrhö, Strikturen, Stenosen, Fibrose, Inkontinenz, Fisteln, Schmerzen und Radioderm führen. Die Behandlung erfolgt in der Regel konservativ, operative Eingriffe sollten vermieden werden. Anorektale Funktionsstörungen können auch als Folge von Operationen im Becken auftreten.

Abstract

Most anorectal symptoms in oncological patients are caused by tumor-induced constipation or diarrhea, its treatment, or the side effects. Hemorrhoids, anal fissures, and external thrombosed hemorrhoids are generally treated topically. During remission, operations might be performed (hemorrhoidectomy, excision of fissures, etc.). Septic lesions arising during chemotherapy (e.g., fistula, abscess, pilonidal sinus) should be treated before/after immunosuppressive therapy, NOT during aplasia. Close cooperation between oncologist and colorectal surgeon is necessary. Under immunosuppressive therapy, perianal infections might develop such as anal herpes, anal zoster, cytomegalovirus infection, pyoderma, fistula, abscess, and unspecific perianal infiltrates. During severe neutropenia these infections are often clinically not typical. Radiotherapy in the pelvic region may cause proctitis, strictures, stenosis, fibrosis, incontinence, fistula, pelvic pain, and radiodermatitis. These lesions should be treated locally or medically. Operative procedures in radiated areas should be avoided. Anorectal disorders might also develop after radical operations in the pelvic region.

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Danksagung

Die Autoren bedanken sich bei Herrn Prof. Dr. Kneba (Direktor der II. Medizinischen Klinik und Poliklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel), Herrn Prof. G. Kovacs [Klinik für Strahlentherapie (Radioonkologie), Universitätsklinikum Schleswig-Holstein, Campus Kiel] sowie bei Karin Jongen für das kritische Durchlesen des Manuskripts und für Verbesserungsvorschläge.

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Authors and Affiliations

  1. Proktologische Praxis und Abteilung Proktologische Chirurgie, Park-Klinik, Kiel

    J. Jongen, H.-G. Peleikis, A. Eberstein & J.-U. Bock

  2. Chirurgische Klinik und Poliklinik, Universität Regensburg

    K. Pfister

  3. Proktologische Praxis und Abteilung Proktologische Chirurgie, Park-Klinik, Goethestraße 11, 24116 , Kiel

    J. Jongen

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  1. J. Jongen
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  2. H.-G. Peleikis
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  3. A. Eberstein
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  4. J.-U. Bock
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  5. K. Pfister
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Correspondence to J. Jongen.

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Jongen, J., Peleikis, HG., Eberstein, A. et al. Proktologische Erkrankungen bei onkologischen Patienten. Onkologe 10, 91–107 (2004). https://doi.org/10.1007/s00761-003-0630-y

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  • DOI: https://doi.org/10.1007/s00761-003-0630-y

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