Complications following formalin installation in the treatment of radiation induced proctitis

Abstract

Formalin installation has been safely and effectively used to treat refractory bleeding caused by radiation proctitis. This study evaluated the results of such treatment in terms of outcome and complications. All four patients who underwent formalin irrigation for transfusion-dependent radiation proctitis over a 15-month period were evaluated retrospectively. The procedure was performed under sedation in the operating room, with patients in the prone jack-knife position. 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. In a fifth patient formalin-soaked gauze pads were applied directly to the injured mucosa. At 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. The procedure, however, is not risk free and may induce major complications such as acute colitis.

Pelvic radiation disease: Updates on treatment options

“…Endoscopic application of formalin is more frequently associated with complications and requires more skilled endoscopists than argon plasma coagulation therapy [65] . The most frequently reported adverse events include ano-rectal pain, fecal incontinence, severe diarrhea, fever and the severe formalin-induced colitis [66] . Other complications include anal or rectal strictures, rectal perforation or ulceration.…”

Recent advances in the management of radiation colitis

“…While topical formalin appears to be slightly less effective than argon plasma coagulation therapy, formalin application alone or a combination of the two treatments has been advocated for severe cases of hemorrhagic radiation proctitis. Although formalin installation may be effective in controlling refractory bleeding due to radiationinduced proctitis, the procedure is not risk-free and may induce major complications such as acute colitis [74] . Preliminary results of a randomized study of the two therapeutic interventions, however, show equivalent efficacy but an absence of effect of either treatment on anorectal dysfunction.…”

Evaluation of the effectiveness of 4% formalin in the treatment of hemorrhagic actinic proctitis

“…Due to the great possibility of technical complications, since local fibrosis is caused by the radiation and the adherence of pelvic organs, the surgical treatment is restrict to local complications (fistulae), persistence of symptoms and uncontrollable bleeding 6 . For patients without surgical roof, it is possible to use the derivation of intestinal transit [8][9] . The formalin has been used since the past century.…”