Yonsei Med J.  2007 Feb;48(1):97-100. 10.3349/ymj.2007.48.1.97.

Formalin Application for the Treatment of Radiation- Induced Hemorrhagic Proctitis

• Lee SI
• Park YA
• Sohn SK

• KMID: 1093529
• DOI: http://doi.org/10.3349/ymj.2007.48.1.97

Abstract

Radiation-induced hemorrhagic proctitis (RIHP) is a serious complication of pelvic irradiation, and a 4% formalin solution has been used for 20 years in treating this sequelae. The first case involving formalin application for treatment of RIHP in Korea was reported in 1996, but there are no additional studies beyond this date. Our study reviews the use of formalin instillation and selective application. The purpose of this study was to retrospectively evaluate the outcome of such treatments, beginning with the first case at our hospital. From 1996 to 2005, five RIHP patients had received formalin treatment for RIHP symptoms intractable to other medical treatments. All treatments were performed by a single surgeon in the operating room, under spinal anesthesia or intravenous sedation. The mean duration of symptoms before treatment was 15.6 months (which was longer than in other studies), and the transfusion before treatment varied from once per month to twice per week. Using sigmoidoscopy, 100ml of a 4% formalin solution was instilled directly (or by using a formalin-soaked gauze) and irrigated for five minutes. Formalin-soaked cotton was then applied selectively to focal remnant lesions. Four patients improved after the first treatment, but one patient received the treatment twice because of recurrent symptoms. Complications after treatment included perianal pain (one case), and aggravated incontinence (one case), which improved three months after conservative management. In conclusion, the formalin combination application method in our study is comparable to other formalin treatments for intractable RIHP.

Keyword

Radiation-induced hemorrhagic proctitis; formalin

Reference

1. Otchy DP, Nelson H. Radiation injuries of the colon and rectum. Surg Clin North Am. 1993. 73:1017–1035.

2. Woo TC, Joseph D, Oxer H. Hyperbaric oxygen treatment for radiation proctitis. Int J Radiat Oncol Biol Phys. 1997. 38:619–622.

3. Gilinsky NH, Burns DG, Barbezat GO, Levin W, Myers HS, Marks IN. The natural history of radiation-induced proctosigmoiditis: an analysis of 88 patients. Q J Med. 1983. 52:40–53.

4. Parikh S, Hughes C, Salvati EP, Eisenstat T, Oliver G, Chinn B, et al. Treatment of hemorrhagic radiation proctitis with 4 percent formalin. Dis Colon Rectum. 2003. 46:596–600.

5. Hurtig A. Local hydrocortisone acetate for radiation proctitis. Postgrad Med. 1954. 15:37–39.

6. Blank WA. Irradiation injury to the bowel and rectum. Proc R Soc Med. 1970. 63:Suppl. 98–100.

7. Goldstein F, Khoury J, Thornton JJ. Treatment of chronic radiation enteritis and colitis with salicylazosulfapyridine and systemic corticosteroids. A pilot study. Am J Gastroenterol. 1976. 65:201–208.

8. Rubinstein E, Ibsen T, Rasmussen RB, Reimer E, Sorensen BL. Formalin treatment of radiation-induced hemorrhagic proctitis. Am J Gastroenterol. 1986. 81:44–45.

9. de Parades V, Etienney I, Bauer P, Bourguignon J, Meary N, Mory B, et al. Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis--an effective but not risk-free procedure: a prospective study of 33 patients. Dis Colon Rectum. 2005. 48:1535–1541.

10. Pikarsky AJ, Belin B, Efron J, Weiss EG, Nogueras JJ, Wexner SD. Complicatins following formalin installation in the treatment of radiation induced proctitis. Int J Colorectal Dis. 2000. 15:96–99.

11. Lee SI, Park IS, Park HJ, Sohn SK, Song JW, Jung JK, et al. A case of formalin therapy for hemorrhagic radiation proctitis. Korean J Gastrointest Endosc. 1996. 16:793–799.

12. Chautems RC, Delgadillo X, Rubbia-Brandt L, Deleaval JP, Marti MC, Roche B. Formaldehyde application for haemorrhagic radiation-induced proctitis: a clinical and histological study. Colorectal Dis. 2003. 5:24–28.

13. Seow-Choen F, Goh HS, Eu KW, Ho YH, Tay SK. A simple and effective treatment for hemorrhagic radiation proctitis using formalin. Dis Colon Rectum. 1993. 36:135–138.

14. Myers JA, Hollinger EF, Mall JW, Jakate SM, Doolas A, Saclarides TJ. Mechanical, histologic, and biochemical effects of canine rectal formalin instillation. Dis Colon Rectum. 1998. 41:153–158.

15. Ben-Soussan E, Antonietti M, Savoye G, Herve S, Ducrotte P, Lerebours E. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe. Eur J Gastroenterol Hepatol. 2004. 16:1315–1318.

16. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. 2002. 87:134–143.

17. Gul YA, Prasannan S, Jabar FM, Shaker AR, Moissinac K. Pharmacotherapy for chronic hemorrhagic radiation proctitis. World J Surg. 2002. 26:1499–1502.