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Wednesday, 4 December 2013

Proctitis – The Symptoms

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.
II. The Symptoms
1. Rectal bleeding and anal discomfort
There is a report of a A 45-year-old man was referred to our surgical clinic for investigation of rectal bleeding and anal discomfort. is a sexually transmitted infection caused by Chlamydia trachomatis. There are few reports describing rectal stricture as a late complication of chronic proctitis associated with lymphogranuloma venereum (LGV) infection. Lymphogranuloma venereum (LGV)proctitis is often mild, but chronic cases can be associated with serious complications. If LGV is misdiagnosed or partially treated, the natural history of chronic long-lasting inflammation of the rectum may include the development of fissures, perianal abscess and strictures of the rectum(11).
2. Change of Singapore General Hospital
According to the Singapore General Hospital study of review, 77 patients were 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 most common presenting symptom was bleeding per rectum (89.6 percent), with a change in bowel habits a distant second (10.4 percent)(12).
2. Constipation
There is a report of a 72-year-old white woman presenting with a large abdominal mass, who had at least 4 episodes of radiographically demonstrated fecal impaction over the previous year without adequate treatment. The patient required hospitalization for a bleeding rectal ulcer during the second episode of fecal impaction. Computed tomography (CT) scans on this admission revealed a dilated colon up to 16 x 14 cm in maximal dimensions extending over 30 cm, filled with massive fecal material, according to the study by the College of Osteopathic Medicine, Ohio University, Athens(13).
3. Urgency, diarrhea, and tenesmus
According to the study of 50 patients to compare colonic irrigation and oral antibiotics (irrigation group) versus 4% formalin application (formalin group) for treatment of hemorrhagic radiation proctitis by Chulalongkorn University, Bangkok, showed that treatment with daily self-administered colonic irrigation with 1 L of tap water and a 1-week period of oral antibiotics (ciprofloxacin and metronidazole) indicated a a significant improvement in rectal bleeding and bowel frequency in both treatment groups, but significant improvement in urgency, diarrhea, and tenesmus was demonstrated only in the irrigation group(15).
4. Anorectal pain, discharge and change in stool frequency
The University Hospital, Zurich, Switzerland report a study since 2003, there are twelve cases of proctitis, all in men having sex with men (MSM), caused by the LGV serovar L2 C. In the observation of trachomatis, of the overall 11 patients the majority were HIV positive and only 2 were HIV negative. Only one patient reported previous sexual contacts outside Europe (Thailand) as the likely place of infection. The clinical presentation was characterised by anorectal pain, discharge, tenesmus and change in stool frequency(16).
5. Blood in stool
In most cases, blood in stool is presented for patient with ulcerative proctitis.
6. Ulcers, and occasionally lymphadenopathy and fever
Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, ulcers, and occasionally lymphadenopathy and fever, according to the study by the University of Chicago Medical Center(14)
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Sources
(11) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386211/
(12) http://www.ncbi.nlm.nih.gov/pubmed/20505910
(13) http://www.ncbi.nlm.nih.gov/pubmed/17570316
(14) http://www.ncbi.nlm.nih.gov/pubmed/21994137
(15) http://www.ncbi.nlm.nih.gov/pubmed/22965404
(16) http://www.ncbi.nlm.nih.gov/pubmed/20131124