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Thursday, 5 December 2013

Proctitis – The Complications

Proctitis is defined as a condition of inflammation of the anus and the lining of the rectum (i.e., the distal 10–12 cm) of that can lead to bowl discomfort, bleeding, a discharge of mucus or pus, etc.
A. Complications
A.1. Diseases complications
1. Intractable bleeding, intestinal obstruction or intra-abdominal sepsis
In the review of 77 patients admitted for the treatment of radiation proctitis, with a median follow-up period of 14 (range 1-61) months. There were 23 male and 54 female patients, with a median age of 63.9 (range 37-89) years.the majority of the patients (72.5 percent) received non-surgical treatment, most commonly using topical 4 percent formalin solution to arrest the bleeding, with more than half the patients requiring repeat treatments. 14 (18.2 percent) patients required colorectal resections for intractable bleeding, intestinal obstruction or intra-abdominal sepsis(17).
2. Syphilis
There is a first report of a case of with simultaneous manifestations of proctitis, gastritis, and hepatitis. The diagnosis of syphilitic proctitis and gastritis was established by the demonstration of spirochetes with anti-Treponema pallidum antibody staining in biopsy specimens. Unusual manifestations of secondary syphilis completely resolved after 4 weeks of antibiotic therapy(18).
3. Bleeding areas in the rectum, internal and/or external hemorrhoids
According to the study by, Surgeons are appropriately concerned about using conventional methods of treatment in patients with radiation proctitis, such as cautery for complications of bleeding areas in the rectum, rubber band ligation, or excision of internal and/or external hemorrhoids, for fear of poor healing and possible exacerbation of the original problem(19).
4. Comstipation
According to the study by University La Sapienza, constipation in ulcerative proctitis (UP), may be correlated with rectal fibrosis, which reduces the transit of stools from the left colon. The concomitance of asymptomatic anorectal organic or functional alteration may contribute to worsen constipation(20).
5. Increased irritation to the anal and rectal area in patients with proctitis.
6. Etc.
A.2. Complications after treatment
1. Formalin installation treatment
Inn the study to evaluate the results of formalin installation treatment in terms of outcome and complications with a solution of 4% formalin was introduced in aliquots of 50 ml kept in contact with the mucosa for 30 s and then cleared away using saline irrigation; five to six aliquots were used in each session, showed that in a mean follow-up of 18 months (range 6-26), two patients had repeat episodes of bleeding, one underwent successful repeat irrigation, and the other refused further treatment. One patient suffered from severe anococcygeal pain and worsening of incontinence after the procedure. The pain was treated with lidocaine ointment and sitz baths with partial success. Another patient developed severe formalin-induced colitis 5 days after the procedure, which required intravenous antibiotics and hydration. Formalin installation may be effective in controlling refractory bleeding due to radiation induced proctitis(21).
2. Systemic isotretinoin therapy
Isotretinoin’s best-known and most dangerous side effect is birth defects due to in utero exposure. There is a report of complications of anal fissure, rectal bleeding and proctitis with the systemic isotretinoin therapy(22).
3. Etc.
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Sources
(17) http://www.ncbi.nlm.nih.gov/pubmed/20505910
(18) http://www.ncbi.nlm.nih.gov/pubmed/21998411
(19) http://www.ncbi.nlm.nih.gov/pubmed/22714783
(20) http://www.ncbi.nlm.nih.gov/pubmed/16917226
(21) http://www.ncbi.nlm.nih.gov/pubmed/10855551
(22) http://www.ncbi.nlm.nih.gov/pubmed/17062102