Proctitis in Emergency Medicine Treatment & Management

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jun 2, 2010
 

Emergency Department Care

  • After life-threatening conditions have been excluded or controlled, aim for providing patient comfort during the examination.
  • Treatment depends upon the etiology.
    • Sitz baths, antispasmodic medications, stool softeners, low residue diet (may provide relief)
    • Steroid enemas or suppositories for ulcerative proctitis
    • Ceftriaxone and doxycycline for gonorrheal proctitis
    • Acyclovir for herpetic proctitis
    • Tetracycline or doxycycline for chlamydial proctitis
    • Shigella proctitis is usually self-limiting but may require, under certain circumstances, prolonged (2-4 wk) antibiotic treatment with ampicillin, tetracycline, ciprofloxacin, or trimethoprim and sulfamethoxazole (TMP-SMZ).
    • Yersinia proctitis is usually self-limiting, but, if systemic bacteremia occurs, treat with intravenous antibiotics such as tetracycline or ceftriaxone.
    • Campylobacter proctitis is a self-limiting disease; treatment is aimed at symptomatic relief.
    • Metronidazole (Flagyl) or iodoquinol for amebiasis proctitis
    • Metronidazole (Flagyl) or oral vancomycin for C difficile proctitis
    • Radiation proctitis treatment may include the following: sucralfate alone or with rectal prednisolone enemas, short-chain fatty acid enemas, or pentosan polysulfate. In addition, hyperbaric oxygen theoretically inhibits bacterial growth, preserves marginally perfused tissue, and inhibits toxin production. Formaldehyde, argon plasma coagulation via endoscopy and bipolar electrocoagulation (BiCap) may be used to control refractory bleeding in hemorrhagic proctitis.[3, 4, 5]
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Consultations

  • Consult a colorectal surgeon or a gastroenterologist for further evaluation of the lower gastrointestinal (GI) tract by sigmoidoscopy, if indicated (to rule out more proximal disease), after anoscopy.
  • A colorectal surgical consultation may also be considered for management/evaluation of deep tissue infection that is not amenable to incision and drainage in the ED.
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Contributor Information and Disclosures
Author

Lisandro Irizarry, MD, MPH, FAAEM  Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine

Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Ibis Yarde, MD  Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

  1. Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. October 7, 2009. Accessed. March 14, 2010. UpToDate [online].

  2. Hille A, Schmidt-Giese E, Hermann RM, Herrmann MK, Rave-Frank M, Schirmer M, et al. A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment. Scand J Gastroenterol. Jan 2008;43(1):52-8. [Medline].

  3. Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy. Jun 2009;41(6):529-31. [Medline].

  4. Haas EM, Bailey HR, Farragher I. Application of 10 percent formalin for the treatment of radiation-induced hemorrhagic proctitis. Dis Colon Rectum. Feb 2007;50(2):213-7. [Medline].

  5. de Parades V, Etienney I, Bauer P, Bourguignon J, Meary N, Mory B, et al. Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis--an effective but not risk-free procedure: a prospective study of 33 patients. Dis Colon Rectum. Aug 2005;48(8):1535-41. [Medline].

  6. Babb RR. Radiation proctitis: a review. Am J Gastroenterol. Jul 1996;91(7):1309-11. [Medline].

  7. Bassford T. Treatment of common anorectal disorders. Am Fam Physician. Apr 1992;45(4):1787-94. [Medline].

  8. Bitton A. Medical Management of Ulcerative Proctitis, Proctosigmoiditis, and left-sided colitis. Semin Gastrointest Dis. 2001;12(4):263-274. [Medline].

  9. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. Jul 15 2002;87(2):134-43. [Medline].

  10. [Guideline] Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Jul 2004;99(7):1371-85. [Medline].

  11. Liauw SL, Sylvester JE, Morris CG, Blasko JC, Grimm PD. Second malignancies after prostate brachytherapy: incidence of bladder and colorectal cancers in patients with 15 years of potential follow-up. Int J Radiat Oncol Biol Phys. Nov 1 2006;66(3):669-73. [Medline].

  12. MacDermott RP. Management of ulcerative proctitis, proctosigmoiditis and left sided colitis. Available at www.uptodate.com. Accessed March 31, 2009.

  13. Rafal RB, Nichols JN, Cennerazzo WJ, et al. MRI for evaluation of perianal inflammation. Abdom Imaging. May-Jun 1995;20(3):248-52. [Medline].

  14. Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastroenterol. Oct 2004;38(9):733-40. [Medline].

  15. Spencer CM, McTavish D. Budesonide. A review of its pharmacological properties and therapeutic efficacy in inflammatory bowel disease. Drugs. Nov 1995;50(5):854-72. [Medline].

 
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