Pelvik radyoterapiye bagli olarak gelisen rektosigmoiditin tedavisinde topikal formalin infüzyonunun yeri
Topical formalin infusion therapy for hemorrhagic rectosigmoiditis caused by pelvic radiation therapy
- Ana Sayfa
- Sayılar
- Pelvik radyoterapiye bagli olarak gelisen rektosigmoiditin tedavisinde topikal formalin infüzyonunun yeri...
Özet
Giris ve amaç: Radyoterapiye bagli kronik dönem hemorajik rektosigmoiditli 4 olgunun topikal formalin infüzyon tedavisi sonuçlarini irdelemek. Gereç ve yöntem: Pelvik radyoterapi sonrasi rektal kanama gelisen 4 olgu çalismaya alindi. Rektosigmoidoskopide lezyonlari splenik fleksurayi asanlar ile fistül veya striktür saptananlar çalisma disinda bi- rakildi. Hastalik aktivitesi endoskopik olarak hafif, orta ve agir seklinde belirlendi. Olgulara ayni seansta, % 4’lük formaldehid 20 cc ile toplam 4 kez, mukozal temas süresi 15 dakika olacak sekilde rektal lavman yapi ldi. Klinik takibin yani sira 4. hafta ve 6. ayda rektosigmoidoskopik kontroller yapildi. 4. haftada yeterli yanit alinamamis ise ayni islem tekrarlandi. Bulgular: Olgularin tümünde diski düzeninde bozulma ve rektal kanama mevcuttu. Rektosigmoidoskopik olarak agir aktiviteli (skor 11-14) radyasyon rektosigmoiditi gözlendi. Topikal formalin infüzyonu sonrasi erken dönemde hiçbir vakada komplikasyon gelismedi. Dördüncü haftada semptomlarda ve kan tablosunda belirgin düzelme gözlenirken, endoskopik degerlendirmede lezyonlarda gerileme olmayan 3 olguya islem tekrarlandi. Bir olguda 2. dozdan 1 ay sonra rektovaginal fistül gelistigi için cerrahi rekonstrüksiyon uygulanirken diger 3 olgunun 6. ay rektosigmoidoskopi kontrollerinde belirgin düzelme saptandi. Bir olgu prostat Ca’nin metastatik etkisi ile 9. ayda kaybedildi. Diger 2 olgunun 16 aylik takibinde kan transfüzyonu ihtiyaci olmadigi ve yakinmalarinin büyük oranda geriledigi gözlendi. Sonuç: Pelvik radyoterapiye bagli gelisen hemorajik rektosigmoiditin tedavisinde % 4 lük lokal formalin tedavisi ucuz, etkin, kolay ve komplikasyon orani düsük bir seçenek olabilir.
Abstract
Background and aim: In this study, the results of topical formalin infusion therapy on four cases with hemorrhagic rectosigmiditis caused by pelvic radiation therapy were evoluated. Material and methods: Four cases with rectal bleeding commencing after radiotherapy were included in the study. Cases with fistulas and strictures or with lesions proximal to the splenic flexura had been excluded. Disease activity was determined clinically and endoscopically as mild, moderate and severe. A rectal enema consisting of 20 ml. of 4 % formalin was administered in the colonic lumen with a contact duration of 15 minutes, and this was repeated four times in one session. Rectosigmoidoscopic follow up was undertaken along with clinical examination during the fourth week and sixth month, if there was no significant improvement at the fourth week, the procedure was repeated. Results: All cases had changed bowel movements and rectal hemorrhage. Radiation sigmoiditis with severe activity (score 11-14) was seen in all cases. There were no complications initialy after formalin infusion. Definite improvement in symptoms and in blood counts at the fourth week was observed. The same procedure was repeated for three patients because no regression was seen. While surgical reconstruction was performed on a patient who had rectovaginal fistulas which developed one month later on second dose of formalin therapy, there was a definite improvement in lesions at the six month rectosigmoidoscopic follow-up of the other three patients. One patient died due to metastasis of prostate cancer at the ninth months. There was neither blood transfusion requirement nor any clinical complaint in the other two cases during sixteen months of follow-up. Conclusion: Local formalin therapy may be a cheap, effective and convenient alternative method which has a low complication rate in hemorrhagic rectosigmoiditis caused by pelvic radiotherapy.
