Anorectal: Proctitis

Infectious Proctitis

Basics

  • Inflammation of the Anorectal Mucosa
  • Most Common Cause of Proctitis
  • Most Common in Gay Males from Anal Intercourse
  • Can Mimic IBD or Other Causes of Proctitis

Organisms

  • Neisseria gonorrhea – Most Common
  • Chlamydia trachomatis
    • Lymphogranuloma Venerum (LGV) – Ulcerative Disease Caused by Chlamydia
  • Herpes Simplex Virus (HSV)
  • Syphilis

Symptoms

  • Tenesmus (Recurrent Feeling of Need to Evacuate Bowels) – Most Common Symptom
  • Pain
  • Bleeding
  • Diarrhea
  • Mucous Discharge
  • Fever

Treatment

  • Initial Empiric Coverage: Ceftriaxone & Doxycycline
    • Ceftriaxone Covers Gonorrhea & Doxycycline Covers Chlamydia
  • Other Causes:
    • HSV: Acyclovir
    • Syphilis: Penicillin

Infectious Proctitis 1

Radiation Proctitis

Basics

  • Epithelial Damage of the Rectum & Anus from Radiation Exposure
  • Minimal-No Inflammation (Proctitis is a Misnomer)

Presentation

  • Acute Radiation Proctitis
    • Within 6 Weeks of Treatment
    • From Direct Radiation Damage
    • 20% Will Have Sx Severe Enough to Necessitate Interruption of Radiation Tx
  • Chronic Radiation Proctitis
    • Months-Years After Treatment
    • Obliterative Arteritis of Submucosal Vessels with Progressive Atrophy & Fibrosis

Symptoms

  • Diarrhea
  • Bleeding – Typically More Severe if Chronic
  • Pain
  • Constipation if Strictured
  • Tenesmus (Recurrent Feeling of Need to Evacuate Bowels)

Diagnosis

  • Clinical & Rule Out Other Causes
  • Endoscopic Findings Nonspecific

Treatment

  • Acute Tx: Supportive
    • Hydration
    • Antidiarrheals
    • Butyrate Enemas (SCFA Colonocyte Nutrient)
    • Sucralfate Enemas (Create Barrier)
  • Chronic Tx:
    • Mild Sx: Nothing
    • Severe Sx: Sucralfate Enemas
      • If Fails: Endoscopic Argon Plasma Coagulation (APC)
      • If Symptoms Intractable: Surgery

Radiation Proctitis 2

Other Causes of Proctitis

Inflammatory Bowel Disease (IBD)

Pouchitis After Ileal Pouch-Anal Anastomosis (IPAA)

Neutropenic Enterocolitis (Typhlitis)

Diversion Proctitis

References

  1. Sandgren KE, Price NB, Bishop WP, McCarthy PJ. Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male. Case Rep Pediatr. 2017;2017:3547230.(License: CC BY-4.0)
  2. Lam MC, Parliament M, Wong CK. Argon plasma coagulation for the treatment of hemorrhagic radiation colitis. Case Rep Gastroenterol. 2012 May;6(2):446-51. (License: CC BY-NC-ND-3.0)