Gómez NL, Aguilar PS, Kerner B, Madhavan J, Lindsey M, Park J, Giammar D

Language: English
References: 2
Page: 18-20
PDF size: 30.03 Kb.

ABSTRACT

Purpose: Retrospective review of cases from 2000-2005 evaluating the efficacy and technique of formalin instillation for treatment of bleeding caused by radiation induced proctitis. Methods: Twenty-one patients underwent 4% formalin instillation after exhausting conventional medical therapy. Results: Charts were reviewed from two colorectal surgery groups in Columbus, Ohio. Twenty-one cases were identified between 2000 and 2005. Six practicing colorectal surgeons participated in the study. Mean age of patient population was 70 years (range 50-85). All but one patient studied was male. The indication for formalin instillation was recalcitrant bleeding after prostate irradiation in the male population, and one female with irradiation for cervical cancer. All patients had previous medical treatments with combination of mesalamine suppositories, hydrocortisone enemas, IRC/APC or electrocoagulation. Two patients required transfusions (9.5%). Because of the heterogeneity of the two groups, and individual surgeons, surgical technique varied. Technique of application is classified into three groups: Formalin soaked guaze instillation, formalin irrigation, and a combination of both. Contact time varied from 1-5 minutes, with majority of surgeons applyling formalin for 1 minute duration. Eleven of 21 patients (52%) stopped bleeding after first session. Six (29%) required a second treatment for cessation of bleeding after recurrence. Four patients were characterized as partial responders and were further treated with medical management. Thus an 81% success rate was seen with this procedure, in accordance with what is reported by other investigators. Complications from the procedure was seen in 6 patients (28%). Including 1 patient with chemical rectosigmoiditis, 1 patient with tenesmus, 3 patients with rectal pain, and one patient with anal fissure. Conclusions: Formalin irrigation is efficacious in the treatment of bleeding caused by radiation induced proctitis and should be used as an adjunct when other conventional therapies have failed. It should be remembered that the procedure is not innocuous and does have local morbidity.

REFERENCES

1. Rubinstein E, Ibsen T, Rasmussen RB, Reimer E, Sorensen BL. Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol 1986; 81: 44-5.

2. Johnston MJ, Robertson GM, Frizelle FA. Management of late complications of pelvic radiation in the rectum and anus. Dis Colon Rectum 2003; 46: 247-59.