[The treatment of rectorrhagia secondary to postradiation proctitis with 4% formalin]

Radiation proctitis is a common complication of radiotherapy for pelvic malignancies. In the chronic form it might lead to intractable or massive hemorrhage unresponsive to conventional therapy. In these cases surgery is associated with a high morbidity. Seven female patients previously treated with external beam radiation for carcinoma of the uterus and cervix were included. They had required multiple blood transfusions (median 2), and still had low hemoglobin rates and active hemorrhagic radiation proctitis, were treated. Therapy was accomplished by direct application of gauzes soaked in 4% formalin through the rigid sigmoidoscope or the Pratt anoscope, with the patients under peridural anesthesia. Gauzes were laid in contact with the hemorrhagic surface during 4 minutes and repeated until the bleeding ceased (median total exposure time was 26 minutes). Bleeding ceased immediately in 6 patients, one continued with minor bleeding after formalin treatment, two patients had fever during the first 24 hours which was controlled with physical measures, three patients required repeat formalin application (in external bases), after that six patients had no further bleeding nor was any blood transfusion needed, one patient presented unsuspected sigmoid bleeding stenosis. The formalin therapy is an effective, safe, simple and inexpensive treatment for rectal bleeding caused by radiation proctitis.