Two Percent Formalin Retention Enemas for Hemorrhagic Radiation Proctitis: A Preliminary Report

Abstract

The short-term safety and efficacy of 2 percent formalin administered as a retention enema for hemorrhagic radiation proctitis was studied. A group of 24 patients with hemorrhagic radiation proctitis who received radical radiotherapy were administered 2 percent formalin as a retention enema and the treatment was followed up from 1 to 29 (mean, 15.34) weeks. The enema was performed on an outpatient basis under sedation with pentazocine and promethazine with a retention time of two minutes. The symptoms and proctoscope findings were graded and converted into a numeric score, ranging from 1 to 4. The mean improvements in scores before treatment and after the last follow-up were analyzed for statistical significance by using the paired t-test. There was complete cessation of bleeding in 47.8 percent of patients and very negligible bleeding in 30.4 percent. A total of 78.2 percent responded positively to treatment with 2 percent formalin retention enema. More than one application was required in 34.7 percent of the patients. The procedure was well tolerated and most of the side effects were mild. Side effects were diarrhea in 23.5 percent, abdominal pain and tenesmus in 8.8 percent, and fever with vomiting in 2.9 percent of patients. There was a statistically significant reduction in bleeding and proctoscopy scores (P<0.01). None of the patients in this study required surgery to palliate their symptoms. Two percent formalin when given as a retention enema is a safe, inexpensive, and effective intervention for hemorrhagic radiation proctitis. Any trained health worker using simple precautions can perform this procedure. The long-term efficacy and safety of 2 percent formalin retention enemas need further assessment with randomized, controlled trials.