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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 74 No. Supl 1, 2020.

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THERAPEUTIC APPROACH TO HEMORRHAGIC SHOCK CAUSED BY RADIATION PROCTITIS

NIKOLA KOČET ; Department of Emergency Medicine of Varaždin County, Varaždin, Croatia
DAMIR ROŠIĆ ; Department of Emergency Medicine of Primorje-Gorski Kotar County, Rijeka, Croatia
VIŠNJA NESEK ADAM orcid id orcid.org/0000-0002-6521-4136 ; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Sveti Duh University Hospital, Emergency Department, Josip Juraj Strossmayer University in Osijek, Faculty of Medicine, Osijek, Croatia
TATJANA GORANOVIĆ ; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Josip Juraj Strossmayer University in Osijek, Faculty of Medicine, Osijek, Croatia
MARIJA PLEŠE ; Department of Emergency Medicine of Varaždin County, Varaždin, Croatia
LUCIJA STOJČIĆ ; Institute of Emergency Medicine, City of Zagreb, Zagreb, Croatia

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Abstract

Radiation proctitis indicates infl ammation and damage to lower parts of the colon that occur after exposure to x-ray radiation or other ionizing radiation in the context of radiation therapy of malignant pelvic tumors. Studies show that 50%-70% of patients develop acute and 5%-11% chronic gastrointestinal impairment. The mechanism of injury involves direct damage to the DNA molecule and formation of free radical oxygen that damages mucosa, submucosa and muscle layer, and eventually the serous intestinal lining. In this article, we present a patient in whom hemorrhagic radiation proctitis developed 2.5 years after radiation therapy for prostate carcinoma, which was followed by massive bleeding and hemorrhagic shock. Although there is no standard treatment regimen, there are certain therapeutic options that are currently used in the treatment of hemorrhagic radiation proctitis, and include the use of anti-infl ammatory drugs and antioxidants, tranexamic acid, local use of formalin, slip-shaped corticosteroid, argon plasma coagulation, radiofrequency ablation, hyperbaric oxygen and surgical procedure. On the basis of the present case, the issue of surgical treatment and the extreme need for it are highlighted.

Keywords

radiation proctitis; radiotherapy; hemorrhagic shock; tranexamic acid

Hrčak ID:

236633

URI

https://hrcak.srce.hr/236633

Publication date:

16.3.2020.

Article data in other languages: croatian

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