acute radiation proctitis

Q; 38 year old female is admitted to oncology ICU for observation after her pelvic radiation session due to pelvic pain. Which of the following is unlikely for acute radiation proctitis? (select one)

A) diarrhea

B) mucus discharge

C) urgency

D) tenesmus

E) rectal bleeding

Answer: E

Rectal bleeding is rare in acute radiation proctitis. The most likely symptoms are abdominal or pelvic pain, diarrhea, mucus discharge, urgency, and tenesmus. 

Formaldehyde 4%–10% is the treatment of choice to apply over the mucosa of affected areas under direct vision via proctoscopy. Hyperbaric oxygen has also been described. In severe cases surgical intervention may be needed.

References:

1. Isenberg GA, Goldstein SD, Resnik AM. Formalin therapy for radiation proctitis. JAMA. 1994 Dec 21;272(23):1822

2. Oscarsson N, Arnell P, Lodding P, Ricksten SE, Seeman-Lodding H. Hyperbaric oxygen treatment in radiation-induced cystitis and proctitis: a prospective cohort study on patient-perceived quality of recovery. Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):670-5

3. Jao SW, Beart RW, Gunderson LL. Surgical treatment of radiation injuries of the colon and rectum. Am J Surg. 1986 Feb;151(2):272-7

4. Dahiya DS, Kichloo A, Tuma F, Albosta M, Wani F. Radiation Proctitis and Management Strategies. Clin Endosc. 2022 Jan;55(1):22-32. doi: 10.5946/ce.2020.288. Epub 2021 Nov 18. PMID: 34788934; PMCID: PMC8831406.