Pelvik radyoterapiye bağli olarak gelişen rektosigmoiditin tedavisinde topikal formalin infüzyonunun yeri

Abstract

Background and aim: In this study, the results of topical formalin infusion therapy on four cases with hemorrhagic rectosigmiditis caused by pelvic radiation therapy were evoluated. Material and methods: Four cases with rectal bleeding commencing after radiotherapy were included in the study. Cases with fistulas and strictures or with lesions proximal to the splenic flexura had been excluded. Disease activity was determined clinically and endoscopically as mild, moderate and severe. A rectal enema consisting of 20 ml. of 4 % formalin was administered in the colonic lumen with a contact duration of 15 minutes, and this was repeated four times in one session. Rectosigmoidoscopic follow up was undertaken along with clinical examination during the fourth week and sixth month, if there was no significant improvement at the fourth week, the procedure was repeated. Results: All cases had changed bowel movements and rectal hemorrhage. Radiation sigmoiditis with severe activity (score 11-14) was seen in all cases. There were no complications initialy after formalin infusion. Definite improvement in symptoms and in blood counts at the fourth week was observed. The same procedure was repeated for three patients because no regression was seen. While surgical reconstruction was performed on a patient who had rectovaginal fistulas which developed one month later on second dose of formalin therapy, there was a definite improvement in lesions at the six month rectosigmoidoscopic follow-up of the other three patients. One patient died due to metastasis of prostate cancer at the ninth months. There was neither blood transfusion requirement nor any clinical complaint in the other two cases during sixteen months of follow-up. Conclusion: Local formalin therapy may be a cheap, effective and convenient alternative method which has a low complication rate in hemorrhagic rectosigmoiditis caused by pelvic radiotherapy.