Beam proktit - the inflammatory pathology of a rectum developing against the background of radiation therapy of cancer of pelvic bodies. Local symptoms include morbidity in rectum projections, mucous, purulent or bloody allocations from an anus. Except local manifestations, beam proktit can be followed also by the general symptoms: temperature increase of a body and the expressed weakness. For diagnosis of a disease the general blood test, a rektoskopiya and a research of dab from a rectum wall is used. Treatment consists in holding local anti-inflammatory procedures, purpose of antibacterial therapy, antihistaminic medicines and vitamin therapy.
Beam proktit represents the nonspecific inflammatory process developing in a mucous membrane of a rectum. Influence of the ionizing radiation when performing radiation therapy concerning cancer of bodies of a small pelvis is the main reason for a disease. Beam proktit is the most common form of radiation damage of intestines which is found in a proktologiya. As about 60% of patients with an oncopathology of bodies of a small pelvis receive radiation therapy, prevalence of damage of a rectum at this group of patients is very high: beam proktit diagnose approximately for 12% of the persons receiving radiation treatment. The main problem which the proctologists observing such patients, this frequent development post-beam a rectum demanding surgery should face.
Reasons of a beam proktit
Beam proktit is always a complication of radiation therapy of an oncopathology of bodies of a small pelvis. Most often this state develops after performing contact gamma therapy of cancer of neck and cancer of a body of a uterus with use of isotopes of thorium, is more rare – at use of pure radium. Also beam proktit can be a consequence of X-ray therapy and remote gamma therapy of cancer of bodies of a small pelvis. Radiation injury of a rectum arises in that case when the total focal dose of radiation exceeds 50 Gr (it is a tolerant dose at which the frequency of late complications makes about 5%). The probability of pathology directly correlates with a radiation dose: the risk of development of a beam proktit increases up to 50% already at an indicator of 65 Gr.
Impact of radiation leads to violation of processes of proliferation and maturing of an epithelium of a rectum, to a deskvamation and an atrophy of cages. The nonspecific inflammation mucous develops and a submucous layer, the muscular layer also can be involved in process. Several months later after radiation therapy the inflammatory process in rectum arteriola leading to chronic violation of blood circulation in the field, to trophic changes and a cicatricial stenozirovaniye is formed. Insufficient microcirculation often becomes the reason of necroses, ulcers which can be complicated by bleeding, perforation, formation of fistulas of a rectum.
Depending on terms of development, beam proktit classify on early (arises in the first 3 months after radiotheraphy) and late (arises after the specified term). On the nature of the morphological changes happening in a rectum distinguish catarrhal, erosive , necrotic and infiltrative and ulcer process. Such complications of a beam proktit as a cicatricial stenosis, rektovezikalny and rektovaginalny fistulas are separately allocated.
Symptoms of a beam proktit
The main manifestations of an early form of a beam proktit are painful desires on defecation. Pain has pristupoobrazny character and amplifies after depletion of intestines. Also the itch and discomfort in the field of back pass can disturb patients. From a rectum slime is often emitted that is a sign of an inflammation of a mucous membrane of intestines. Sometimes the bloody allocations indicating the heavy course of a disease take place. Besides local symptoms, beam proktit is followed by the general clinical manifestations, such as weakness and temperature increase of a body. All symptoms of an early form of pathology usually regress several days later after the end of antineoplastic therapy. However through certain time beam proktit can recur, and the clinical symptomatology often comes back in former volume.
Late radiation injuries of intestines develop approximately in 10% of cases. At the same time the latent period (a period between radiation and emergence of symptomatology) can last from several weeks to 5-10 years. Constant pains in a rectum, a frequent chair in the small portions, and also development of a stenosis with the phenomena of partial impassability are characteristic. Perhaps malosimptomny current of a late form of a beam proktit. In that case the disease is shown by availability of slime in Calais and a periodic pain syndrome in the left podvzdoshny area and in a rectum projection.
Against the background of a beam proktit various complications can develop: intestinal bleeding, ulcers and erosion, rectum stenosis. The striktura of intestines is considered the most terrible and adverse complication from the point of view of the forecast. If against the background of radiation therapy of cancer of bodies of a small pelvis the patient has mucous or bloody allocations from an anus which are followed by tenezma and pain in a rectum it allows to suspect beam proktit.
Diagnostics of a beam proktit
At emergence of signs of a beam proktit against the background of carrying out radiotheraphy of the patient at once direct to the proctologist. For diagnosis of this disease clinical, laboratory and tool methods are used. Inspection begins with objective survey and clarification of complaints. At a beam proktit connection with performing radiation therapy is always traced. From laboratory methods the general blood test in which inflammatory changes, such as , acceleration of SOE and stab shift to the left are, as a rule, noted is applied. Laboratory diagnostic techniques allow to define severity of an inflammation, but they cannot directly be applied to diagnosis of a beam proktit.
A key role in diagnosis of a disease is played by endoscopy. The rektoromanoskopiya is considered the simplest, available and informative method. When carrying out this research the doctor finds reddening, swelled mucous and hyperproduction of slime in a rectum. Besides, the technique allows to reveal the changes characteristic of such complications as bleeding, an abstsedirovaniye, formation of ulcers. Ulcers are, as a rule, localized on a forward wall of a rectum; in a row a case they can lead to formation of fistulas. At a rektoskopiya the biopsy of a mucous membrane of a rectum is surely carried out. It gives the chance to specify severity of inflammatory and atrophic changes of mucous. For the purpose of definition of presence of the infectious agent the bacteriological research of dab from a rectum is conducted.
Because symptoms of a beam proktit have much in common with nonspecific ulcer colitis, the main differential diagnostics has to be carried out between these two diseases. In favor of a proktit the fact of performing radiation therapy in the anamnesis testifies. Besides, beam proktit distinguishes existence of ulcers on a forward wall and in an average third of a rectum. At the same time, at this disease the back wall and the lower part of a rectum extremely seldom is surprised. At nonspecific ulcer colitis inflammatory changes are diffusion and strike all rectal department of intestines. For final differential diagnostics between these two diseases the biopsy is used.
Treatment of a beam proktit
At treatment of a beam proktit it is important to reduce negative impact of ionizing radiation which leads to start of beam reactions. Sick appoint vitamin C, group B vitamins, and also antihistaminic medicines, such as , , and others. In the presence of the expressed inflammation and identification of the infectious activator carry out antibacterial and anti-inflammatory therapy (including, with use of sulfanylamide means, glucocorticoids and sea-buckthorn oil).
Local therapy is an important component of complex treatment of a beam proktit. This type of the help first of all provides clarification of intestines and elimination of local inflammatory processes: in the period of an aggravation enemas with solution of a kollargol or broth of a camomile are shown to patients. Oil microenemas on the basis of cod-liver oil or a vinilin are considered effective. These procedures are carried out after use of depletive or cleaning enemas. The good effect at treatment of a beam proktit gives a warm shower in a rectum or sedentary bathtubs with potassium permanganate use. Also expediently local treatment by glucocorticosteroids, rectal suppositories with mesalaziny and anesthetics.
In complex therapy of a beam proktit an important role is played by healthy nutrition. The diet at this disease provides a complete elimination of spicy, salty and sour food, and also alcohol, restriction of vegetable food and sweet products. The diet at a beam proktit has to contain low-fat meat, soups on broths without fat and fermented milk products. If symptoms of a disease regress against the background of effective treatment, then the diet can be expanded. At development of complications, such as formation of fistulas and narrowings of intestines, surgical methods of treatment, including reconstructive interventions on a rectum are used.
Prevention and forecast of a beam proktit
At a beam proktit forecast generally favorable. The heavy course of pathology is noted at a combination of defeat of several departments of intestines, development of complications in the form of fistulas, bleedings. Timely complex treatment allows to reduce probability of emergence of aggravations. Prevention of a beam proktit consists in use of modern techniques and protocols of treatment of oncological diseases of bodies of a small pelvis which render smaller negative effect on healthy fabrics.