Q) In radiation proctitis surgery is needed in all except
a) Pain Abdomen
b) Rectal stricture
c) Haemorrhage
d) Vesical Fistula
Free Question on management of raiation proctiitis
Ans a, NOT indicated for pain Acute Radiation proctitis - Occurs within 6 mths of starting the treatment Chronic - After 6 mths, Most patients develop symptoms at a median of 8 to 12 months after completion of radiotherapy Modified Radiation Therapy Oncology Group rectal toxicity scale Medical Endoscopic Surgery Diverting ostomies for severe stricture - Better for incontinence, stricture and limited benefit for bleed Reconstruction with Flaps - rectourethral or rectovaginal fistula with a pedunculated gracilis or a Martius flap to facilitate healing by introducing well-vascularized healthy tissue, Proctectomy complicated fistulous disease, especially when accompanied by significant pain and incontinence, or in cases of severe and intractable bleeding
Grade 1
Mild and self-limiting
Minimal, infrequent bleeding or clear mucus discharge, rectal discomfort not requiring analgesics, loose stools not requiring medications
Grade 2
Managed conservatively, lifestyle (performance status) not affected
Intermittent rectal bleeding not requiring regular use of pads, erythema of rectal lining on proctoscopy, diarrhea requiring medications
Grade 3
Severe, alters patient lifestyle
Rectal bleeding requiring regular use of pads and minor surgical intervention, rectal pain requiring narcotics, rectal ulceration
Grade 4
Life threatening and disabling
Bowel obstruction, fistula formation, bleeding requiring hospitalization, surgical intervention required
Prevention
Treatment of radiation proctitis