Intramural Formalin Injection for Rectal Ulcer Refractory to Medical and Endoscopic Treatment

Excerpt

To the Editor—I read with great interest the article by Dr. Raman from Hyderabad, India.1 The short-term safety and efficacy of 2 percent formalin retention enema was reported in a group of 24 patients with hemorrhagic radiation proctitis. Patients with previous topical formalin treatment were excluded from the study. The enema was administered on an outpatient basis. A positive response was noted in 78.2 percent of the patients. Side effects, such as abdominal pain, tenesmus, and/or fever, occurred in 35.2 percent of patients, but only two patients required admission to control their symptoms. Repeated formalin enema was necessary in 34.7 percent of patients. During a mean follow-up of 15.34 weeks, none of the patients needed operative intervention to palliate their symptoms. Although most patients witnessed symptomatic relief and improvement, most remained anemic without a significant rise in hemoglobin level during the study period. …