Radiation proctitis denotes the radiation damage of rectum caused by radiotherapy to pelvic malignancy. The clinical practices of radiation proctitis should be fully considered from diagnosis, treatment and prevention. In order to determine appropriate treatment strategies, the diagnosis of radiation proctitis should be based on clinical symptoms, endoscopic findings, imaging and histopathology to assess severity of symptoms and stage of disease. In terms of treatment decisions, non-surgical interventions are generally applied to relieve major symptoms and avoid serious complications. Diverting colostomy and restorative resection are the main surgical treatments for patients with recurrent symptoms. In terms of prevention, radiation proctitis should be prevented by improvement of radiotherapy technology, physical protection and prophylactic medication. This guide aims to provide guidance for the clinical practices of radiation proctitis in China.
China ; Consensus ; Humans ; Proctitis ; diagnosis ; therapy ; Radiation Injuries ; diagnosis ; prevention & control ; therapy ; Rectum ; pathology ; radiation effects

We report three cases of solitary rectal ulcer syndrome (SRUS). The diagnosis was established according to histopathologic criteria. But, the initial clinical diagnosis was carcinoma, non-specific ulcer and localized proctitis respectively. SRUS is considered as one of functional disorder in pelvic floor which might go underdiagnosed due to unfamiliar concept in Korea. So we should consider SRUS to be one of the differential diagnosis in cases of complaining anorectal symptoms.
Case Report ; Diagnosis, Differential ; Female ; Human ; Middle Age ; Proctitis/diagnosis ; Proctoscopy ; Rectal Diseases/*diagnosis/pathology ; Rectal Neoplasms/diagnosis ; Syndrome ; Ulcer/diagnosis/pathology

Proctitis is an inflammatory change of rectal mucosa induced by various agents or stimulus. Among many etiologies, it may be caused by medical treatments such as radiation or antibiotics. Proctitis usually presents with rectal ulcer but abscess formation is uncommon. Therapy using Ssukjwahun exerts its effect by directly applying the smoke around genital area and anus with various medicinal brewed herbs, especially worm-wood. Secondary metabolite of this plant, monoterpene, is known to facilitate circulation, exert anti-inflammatory effect, and help control pain. Herein, we report an unusual case of infectious proctitis presenting with rectal ulcer and abscess formation after perianal application of warm steam made by Artemisia asiatica smoke for treatment of dysmenorrhea.
Abdomen/diagnostic imaging ; Abscess/*diagnosis ; Adult ; Artemisia/*chemistry/metabolism ; Female ; Humans ; Proctitis/*diagnosis/etiology ; Rectum/diagnostic imaging ; Sigmoidoscopy ; Smoke/*adverse effects ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo investigate risk factors associated with prognosis in patients with radiation proctitis (RP).

METHODSBetween August 2007 and February 2010, 33 patients diagnosed with radiation proctitis were identified. Data pertaining to treatments and quality of life(QOL) were analyzed retrospectively.

RESULTSIndication for radiation included cervical cancer(n=22), prostate cancer (n=3), ovary cancer (n=2), rectal cancer (n=2), endometrial cancer(n=2), cervical cancer (n=1), and vaginal cancer(n =1). Data regarding radiation were available in 18 patients, and the mean dose was (61.3±12.9) Gy with a median dose of 61 Gy. Eleven were treated with enema therapy, 9 formalin dab, 12 surgical operations. Clinical improvement was noticed in 75% of the patients with a mean QOL score of 63.79±20.92. Prognosis was favorable in 75% of the patients. Surgical treatment was effective in 91.7% of the patients with severe complications. Univariate analysis showed that gender was associated with the prognosis of RP, while the severity of RP and treatment method were not predictive for RP prognosis.

CONCLUSIONSGender but not disease severity is associated with the prognosis of radiation proctitis. Surgery may be beneficial to RP patients with severe complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proctitis ; diagnosis ; etiology ; therapy ; Prognosis ; Radiation Injuries ; complications ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Although solitary rectal ulcer syndrome (SRUS) has a characteristic pathologic findings on biopsy specimen, the diagnosis of which often is delayed because this syndrome is easily mistaken for rectal cancer, inflammatory bowel diseases or other forms of proctitis. The mucosal prolapse syndrome has been widely accepted because presence of rectal ulcer is multiple or absent, and this syndrome include related disorder like as colitis cystica profunda. Proctosigmoidoscopy can show variable lesion to differentiate SRUS, which has abnormal gross findings from ulcerative lesions to polypoid lesion, mild proctitis, thickened nodular folds. Endoscopic transrectal ultrasonography (ETUS) has been known to useful procedure to staging and follow up of anorectal carcinoma. ETUS could clearly delineate the rectal wall and its separate layers, and mucosal ulcers or changes in the rectal wall architecture. A 49-year-old female complained of rectal bleeding, mucoid stool and excessive straining with rectal pain. Proctosigmoidoscopic finding revealed irregular rectal ulcers mimicking malignancy. SRUS was diagnosed based on clinical symptom, rectal biopsy and ETUS.
Biopsy ; Colitis ; Diagnosis ; Endosonography ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Middle Aged ; Proctitis ; Prolapse ; Rectal Neoplasms ; Sigmoidoscopy ; Ulcer* ; Ultrasonography

Cytomegalovirus infection is a common complication in patients suffering from advanced acquired immunodeficiency syndrome. Cytomegalovirus infections of the gastrointestinal tract in human immunodeficiency-virus-positive patients tend to manifest as ulcerative lesions rather than as mass lesions. In this study, we describe a case of a mass lesion identified as cytomegalovirus proctitis in a human immunodeficiency-virus-positive patient, which had initially been thought to have an adenocarcinoma or a lymphoma. A 60-year-old man had an ulcerofungating mass in the rectum, which was initially detected via palpation. Findings of computerized tomography indicated a malignant mass, which was enhanced in the contrast image. An additional colonoscopy and biopsy were conducted for purposes of diagnosis. The histological examination revealed characteristic inclusion bodies within the nuclei of vascular endothelial cells in the ulcer bed. Immunohistochemical staining with anti-cytomegalovirus antibody confirmed the diagnosis of cytomegalovirus infection. The patient's anorectal lesion had subsided after the initiation antiviral treatments. The diagnosis of cytomegalovirus infection in human immunodeficiency-virus- positive patients occasionally proves rather difficult. Cytomegalovirus infection had induce the formation of mass lesions in immunocompromised patients.
Acquired Immunodeficiency Syndrome ; Adenocarcinoma ; Biopsy ; Colonoscopy ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diagnosis ; Endothelial Cells ; Gastrointestinal Tract ; Humans ; Immunocompromised Host ; Inclusion Bodies ; Lymphoma ; Middle Aged ; Palpation ; Proctitis ; Rectum ; Ulcer

IgG4-related disease is a relatively new disease entity characterized by elevated serum IgG4 levels and marked infiltration of IgG4-positive plasma cells in lesions. Organ enlargement or nodular lesions consisting of abundant infiltration of lymphocytes and IgG4-positive plasma cells and fibrosis are seen in various organs throughout. We encountered a patient with an inflammatory pseudotumor of the rectum, which was histopathologically confirmed to be an IgG4-related disease. The patient was a 28-year-old woman who had constipation for 3 months. The endoluminal ultrasonography showed a lesion that was heterogeneous and low echogenic in lower rectum. The result of colonoscopic biopsy findings was of chronic proctitis with lymphoid aggregates. For a confirmative diagnosis, excision was performed. Histopathological examination represented plasma cell infiltration and fibrosis. Immunohistochemistry revealed prominence of IgG4-positive plasma cells and confirmed the diagnosis of IgG4-related disease. The patient is currently under observation on low-dose oral prednisolone without relapse.
Adult ; Biopsy ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Fibrosis ; Granuloma, Plasma Cell ; Humans ; Immunoglobulin G ; Immunohistochemistry ; Lymphocytes ; Plasma Cells ; Prednisolone ; Proctitis ; Rectum* ; Recurrence ; Ultrasonography

Ulcerative colitis is increasing now in Korea, and the diagnosis has become relatively easy because sigmoidoscopy and colonoscopy are frequently used. However, the result of treatment is not satisfactory because the relapse rate is very high. Hence, the aim of treatment is to put this disease into remission as soon as possible and to keep it in remission. The authors reviewed 80 confirmed ulcerative colitis cases which were treated from Feb. 1997 to Sep. 1997 at Song Do Colorectal Hospital. The results are as follows: 1) The male to female ratio for these 80 cases was 41:39, and the most prevalent age group was the 4th decade. 2) The most common clinical symptoms were anal bleeding in 77 cases(96%), diarrhea in 68 cases(85%), and abdominal pain in 21 cases(26%). 3) The extension of the disease were the proctitis in 47 cases(59%), the left - side colitis in 28 cases(35%), the total colitis in 4 cases(5%), and the atypical colitis in 1 case(1.3%). 4) The duration of the disease was below 6 month in 30 cases, 6 months to 1 year in 35 cases, and 1~5 years in 11 cases, and over 5 years in 4 cases. 5) Clinical types were the one-attack-only type(18 cases), the relapsing-remitting type(60 cases), the chronic continuous type(1 case), and the acute fulminating type(1 case). 6) In the 28 cases of left side colitis, the average time to remission depended on the medication was 18 days for a 5-ASA 5-ASA suppository, 14.5 days for a 5-ASA oral steroid, and 8.3 days for a 5-ASA budesonide enema. Thus, a budesonide enema is the most effective medication for obtaining remission. 7) The most commonly suspected predisposing factors for relapse were cessation of medication(58 cases), mental stress(18 cases), physical stress(15 cases), and inadequate diet(8 cases). As indicated above, ulcerative colitis is increasing now in Korea, and the rectum is the most commonly involved site for this disease. Relapsing-remitting ulcerative colitis is the most frequently occurring type. Almost all cases were easily put into remission within 4 weeks, but relapse frequently occurred. Suspected predisposing factors, such as mental stress, physical stress, and inadequate diet, should be avoided in order to prevent relapse, and medication, such as 5-aminosalicylic acid, should be continued to maintain remission.
Abdominal Pain ; Budesonide ; Causality ; Colitis ; Colitis, Ulcerative* ; Colonoscopy ; Diagnosis ; Diarrhea ; Diet ; Enema ; Female ; Hemorrhage ; Humans ; Korea ; Male ; Mesalamine ; Music ; Proctitis ; Rectum ; Recurrence ; Sigmoidoscopy ; Ulcer*

PURPOSE: A new classification of gastrointestinal food allergy was published, but the changes of terminology between previously reported terms and the new ones were in a state of disorder. This has resulted in confusion between medical communication and diagnostic and therapeutic approaches. The clinical observations of infants presenting with gastrointestinal cow milk allergy (GI-CMA) were performed, and the changes in the terminology reviewed through the published Korean literature. METHODS: Between March 2003 and July 2003, data from 37 consecutive infants with GI-CMA, aged 2 weeks to 15 months, were reviewed. The challenge and elimination test of cow milk, and the endoscopic and histologic findings, were used for the seven subdivisions of GI-CMA according to a new classification on the basis of patients' ages, clinical manifestations and location of gastrointestinal lesions. RESULTS: The 37 patients had a mean age of 5.4+/-4.8 months, with those observed in 26 (70.3%) of patients being below 6 months of age. The seven final diagnoses were; cow milk protein-induced enterocolitis (CMPIE) in 12 (32.4%), cow milk protein proctitis (PROC) in 12 (32.4%), IgE-mediated (IGE) in 6 (16.2%), gastroesophageal reflux-associated cow milk allergy (GERA) in 5 (13.5%) and eosinophilic gastroenterocolitis in 2 (5.4%). CMPIE was revealed as the typical type in 7 (18.9%) and the atypical type in 5 (13.5%), and all of typical CMPIE revealed cow milk protein-induced enteropathy. The mean age at symptom onset was 4.3+/-0.8 months, and for those with typical and atypical CMPIE, and PROC and GERA were 3.8+/-4.6, 10.4+/-3.8, 3.4+/-3.9 and 7.8+/-5.7 months, respectively (p<0.05). The period from onset of symptom to diagnosis was 2.4+/-3.3 (0.5~12) months, with those observed in atypical CMPIE and GERA being over 3months. Although the birth weights in all patients were within the 10~90 percentile range, the body weights on diagnoses were below the 3 percentile in 48.6%; IGE 16.7%, EOS 0%, typical CMPIE 85.7%, atypical CMPIE 60.0%, PROC 25.0% and GERA 100% (p<0.05). Through the review of the Korean literature, 8 case reports and 14 original articles for GI-CMA were found. CONCLUSION: GI-CMA is not a rare clinical disorder and is subdivided into seven categories on the basis of the patient's age, clinical manifestations and location of the gastrointestinal lesions. The terms for GI-CMA are changing with new classifications, and careful approaches are necessary for medical communications.
Birth Weight ; Body Weight ; Child* ; Classification* ; Diagnosis ; Enterocolitis ; Eosinophils ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Infant ; Milk Hypersensitivity* ; Milk Proteins ; Milk* ; Proctitis

Systemic lupus erythematosus (SLE) is a multi-system inflammatory disorder that has many symptoms. Gastrointestinal symptoms are common, while colonic involvement in the form of ischemic colitis or a colonic ulcer is rare in SLE. The differential diagnosis of ischemic proctitis with ulceration includes an infected ulcer, ulcerative colitis, Crohn's disease, solitary rectal ulcer colitis, malignant tumor, and lupus colitis. Here, we report a 22-year-old male with abdominal pain and diarrhea, who had a huge rectal ulcer that nearly obstructed the rectosigmoid junction. This turned out to be a rare gastrointestinal manifestation of lupus. He recovered after being treated with high-dose oral steroids. Our case demonstrates that a rectal ulcer is a rare, but important, complication of SLE and can be the initial clinical manifestation of the disease.
Abdominal Pain ; Colitis ; Colitis, Ischemic ; Colitis, Ulcerative ; Colon ; Crohn Disease ; Diagnosis, Differential ; Diarrhea ; Humans ; Lupus Erythematosus, Systemic ; Male ; Proctitis ; Steroids ; Ulcer ; Young Adult