Diverting Loop Colostomy for the Treatment of Refractory Gastrointestinal Bleeding Secondary to Radiation Proctitis

Abstract

Chronic radiation proctitis is an uncommon and serious complication of radiotherapy for pelvic malignancies. It has been suggested that fecal stream diversion decreases bowel irritation, resulting in decreased rectal bleeding. We report on the outcome of patients after a diverting loop colostomy for the treatment of severe radiation proctitis. All consecutive patients with chronic proctitis treated with diverting loop colostomy for bleeding at one institution between October 1991 and June 1999 were studied. Four patients presented with rectal bleeding and diarrhea, and two patients had only bleeding. The mean dose of radiation received was 6,115.11 +/- 955.11 rad. Symptoms of chronic proctitis appeared at varying intervals of time after radiation, ranging from 14 months to 17 years. There were no operative complications. During follow-up (36 +/- 29 months), only one of nine patient continued to bleed. Four patients died during the study (cancer relapse, two patients; heart failure, one patient; one death was caused by severe radiation proctitis). Diverting sigmoid loop colostomy, when performed in properly selected patients with severe bleeding secondary to radiation proctitis refractory to medical management, is well tolerated and effective.

Radiation Proctitis: Current Strategies in Management

“…An ostomy can also improve symptoms related to incontinence and stricture, but it has a limited effect on bleeding. At least one study [67] showed significant improvement in bleeding from a diverting loop colostomy but not complete resolution. Diversion will improve symptoms but without additional interventions, the improvements in symptoms are unlikely to persist after an ostomy reversal.…”

“…Diverting loop colostomy was described in one study as a successful way of controlling bleeding [67], but in many instances, proctectomy may be the only option available. When strictures are an issue, a diversion of the stool stream will often result in a significant improvement of symptoms.…”

A novel treatment for haemorrhagic radiation proctitis using colonic irrigation and oral antibiotic administration

“…Colostomy has been used to treat haemorrhagic radiation proctitis [14]. Although diversion of the faecal stream reduces the bacterial load to the irradiated section of the bowel and decreases the bleeding, it carries the risk of surgical complications.…”

Nonendoscopic therapies for the management of radiation-induced rectal bleeding

“…Faecal diversion with a colostomy or ileostomy rarely controls blood loss completely in those with severe and intractable symptoms [62], and bowel resection may therefore be considered [9]. It should be remembered that the microvascular damage caused by radiation not only causes the symptoms of radiation proctopathy, but also significantly impairs healing after surgery [63].…”