Evaluation and Management of Chronic Radiation Proctitis

CASE SUMMARY: A 79-year-old man with history of prostate cancer, treated with external beam radiation therapy 8 months earlier, presented to the office with bright red blood per rectum and diarrhea. Flexible sigmoidoscopy showed scattered inflammation and patchy telangiectasias in the distal sigmoid and rectum consistent with proctitis (Fig. 1). The patient was prescribed sucralfate enemas. He returned in 2 weeks with mild improvement in his symptoms but persistent bleeding. With the use of rigid proctoscopy, topical formalin was applied in the office which resulted in cessation of bleeding.