Pak J Med Sci 2011 Vol. 27 No. 5 www.pjms.com.pk 1051 INTRODUCTION Radiation therapy is an effective treatment for pelvic malignancies. Radiation proctitis is a well known complication of pelvic radiotherapy. 1-5 1. Feza Ekiz, MD, 2. Mustafa Duman, MD, 3. Sukru Tas, MD, 4. Muhammed Fatih Aydin, MD, Department of Gastroenterology, 5. Musa Akoglu, MD, 1-3,5: Department of Gastrointestinal Surgery, 1-5: Kartal Kosuyolu Training and Research Hospital, Istanbul – Turkey. Correspondence: Mustafa Duman, MD, Kartal Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi; Denizer Caddesi, Cevizli Kavsagi; No:2 Cevizli / Kartal, Istanbul, Turkey. E-mail: drmustafaduman@hotmail.com * Received for Publication: April 9, 2011 * 1 st Revision Received: April 27, 2011 * 2 nd Revision Received: July 22, 2011 * Final Revision Accepted: July 30, 2011 Original Article Formalin application is effective for the treatment of Hemorrhagic Proctitis caused by radiation therapy Feza Ekiz 1 , Mustafa Duman 2 , Sukru Tas 3 , Muhammed Fatih Aydin 4 , Musa Akoglu 5 ABSTRACT Objective: Radiation proctitis is a serious complication due to pelvic radiotherapy after pelvic malignancies. The aim of this study was to evaluate the efficacy of 4% formalin solution enema application in hemorrhagic proctitis caused by radiation therapy. Methodology: From February 2008 to February 2009, 13 patients with hemorrhagic radiation induced proctitis were treated in our clinic with 4% formaldehyde solution enema application. They were followed up to six months after the treatment. Results: In all cases, bleeding ceased after the first application. One of the patients experienced re-bleeding three weeks after the formalin application, and repeated formalin enema application controlled the bleeding. Follow up evaluation at sixth month showed no signs of acute proctitis or rebleeding. Two patients suffered from perianal pain during the first two months after the formalin application, however symptoms improved after that. Conclusion: 4% formaldehyde solution application for treatment of hemorrhagic radiation induced proctitis, can be performed easily and is a well tolerated technique with good long term results. KEY WORDS: Hemorrhagic radiation proctitis, Formaldehyde, Pelvic radiotherapy. Pak J Med Sci October - December 2011 Vol. 27 No. 5 1051-1054 How to cite this article: Ekiz F, Duman M, Tas S, Aydin MF, Akoglu M. Formalin application is effective for the treatment of Hemorrhagic Proctitis caused by radiation therapy. Pak J Med Sci 2011;27(5):1051-1054 Ischemia resulting from progressive submucosal fibrosis and endarteritis obliterans gives rise to telengiectatic neovascularity which is prone to bleeding. 6,7 The initial acute reaction after radiation appears within the first two weeks of treatment and late complications such as bleeding, pain, diarrhea or stenosis may appear in months or years. 2 Chronic radiation injury such as fistula, ulceration, and bleeding occur in 5%-20% of the patients. Chronic radiation induced proctitis leads to recurrent or massive hemorrhage, which may necessitate hospitalization and may require repeated blood transfusions. 2,6,8 Common medical therapy for radiation induced rectal proctitis in clinical practice includes non-steroidal anti-inflammatory agents such as oral or topical sulfasalazine, acetylsalicylic acid and ibuprofen, oral corticosteroids, rectal steroid retention enema, sucralfate enemas and bile-acid sequestering resins, short chain fatty acid enemas.