Treatment of severe actinic rectitis

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Oncologic Surgery

Background:

• Actinic rectitis, characterized by rectal inflammation due to radiation therapy, can lead to severe complications like stenosis or perforation.
• Traditional surgical interventions for advanced actinic rectitis often carry significant risks and morbidity.
• This study addresses the need for effective surgical management in patients with refractory or complicated actinic rectitis.

Observation:

• Three female patients with severe actinic rectitis underwent anterior proctosigmoidectomy and transanal coloanal anastomosis.
• The surgical technique involved total proctosigmoidectomy, anal canal mucosectomy, and manual transanal anastomosis at the pectineal line.
• A protective intestinal shunt was employed in all cases, later closed after recovery.

Findings:

• The surgical procedure was completed without immediate operative or postoperative complications in the three patients.
• One patient experienced deep venous thrombosis, which was successfully treated.
• Postoperative sphincter function was evaluated as very good in one patient and regular in the other two.

Implications:

• The described surgical technique offers a viable and effective option for managing severe actinic rectitis with stenosis or perforation.
• Performing anastomosis with non-irradiated colon segments at the pectineal line minimizes risks associated with the irradiated field.
• This approach facilitates the maintenance of bowel transit and improves functional outcomes in a challenging patient population.