FORMALIN INSTILLATION FOR REFRACTORY RADIATION-INDUCED HEMORRHAGIC PROCTITIS - REPORT OF 16 PATIENTS

PURPOSE: Our goal was to evaluate use of topical (4 percent) formalin in management of radiation-induced hemorrhagic proctitis, refractory t o other methods of treatment. Specifically, we wished to determine its safety, ability to stop bleeding, and complications associated with t herapy. METHODS: Sixteen patients with radiation-induced hemorrhagic p roctitis were treated with topical (4 percent) formalin. All had been previously treated with conservative regimens such as cautery, topical steroids, or laser, but these had failed. Five-hundred milliliters (m i) of a 4 percent formalin solution was instilled into the rectum in 5 0-ml aliquots. Each aliquot was kept in contact with rectal mucosa for approximately 30 seconds. Treatments were performed under local anest hesia in nine patients, sedation only in four, spinal in two, and gene ral in one patient. RESULTS: In 12 patients, bleeding stopped after a single formalin instillation; in 3, bleeding was considerably reduced but continued sporadically. One patient required three treatments befo re bleeding stopped. Four patients developed postoperative anal pain, of which one also had significant tenesmus and reduced capacity. Of th ese four patients, only two had significant anal pain and fissures tha t lasted longer than one month. CONCLUSIONS: Topical (4 percent) forma lin is safe and effective in treatment of radiation-induced hemorrhagi c proctitis. A single treatment will stop bleeding in 75 percent of pa tients.