Radiation Proctitis

A 70-year-old man presented with a 2-month history of intermittent hematochezia. Ten years earlier, he had undergone 6 months of radiation therapy for the treatment of prostate cancer. The total dose of radiation was 64 Gy, and the prostate cancer was cured.

On physical examination, the temperature was 36.5°C, the blood pressure was 150/90 mm Hg, the pulse was 90 beats per minute, and the respiration was 14 breaths per minute. The abdomen was soft, with normal bowel sounds and without tenderness.
On rectal examination, there were blood clots and friable mucosa that bled easily but no hemorrhoids or palpable masses. The results of analyses of blood and urine were normal.

Colonoscopy revealed fine, tortuous blood vessels and telangiectasias in the rectum (figure). Histopathological evaluation revealed telangiectatic blood vessels with adjacent hyalinization of the lamina propria. Radiation proctitis was diagnosed, and the patient was given argon plasma coagulation therapy.
During 15 months of follow-up, he had mild tenesmus and infrequent, small amounts of hematochezia that did not require further intervention.