Annals of Coloproctology

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Original Articles

Colorectal cancer

Preventive efficacy of hydrocortisone enema for radiation proctitis in rectal cancer patients undergoing short-course radiotherapy: a phase II randomized placebo-controlled clinical trial: Mohammad Mohammadianpanah, Maryam Tazang, Nam Phong Nguyen, Niloofar Ahmadloo, Shapour Omidvari, Ahmad Mosalaei, Mansour Ansari, Hamid Nasrollahi, Behnam Kadkhodaei, Nezhat Khanjani, Seyed Vahid Hosseini; Ann Coloproctol. 2024;40(5):506-514. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2024.00192.0027

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Purpose
This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT).
Methods
This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3–4 and/or N1–2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis.
Results
Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P<0.001), diarrhea (P=0.023), and rectal pain (P<0.001) than those in the placebo arm. Additionally, the duration of acute gastrointestinal toxicity following SCRT was significantly shorter in patients receiving hydrocortisone (P<0.001).
Conclusion
Hydrocortisone enema was associated with a significant reduction in the severity of proctitis, diarrhea, and rectal pain compared to placebo. Additionally, patients treated with hydrocortisone experienced shorter durations of gastrointestinal toxicity following SCRT. This study highlights the potential benefits of hydrocortisone enema in managing radiation-induced toxicity in rectal cancer patients undergoing radiotherapy.

Citations

Citations to this article as recorded by

Development of Eudragit-Based Nanofiber Formulations for Colon-Targeted Delivery of Hydrocortisone in Inflammatory Bowel Disease
Fatmanur Tuğcu-Demiröz, Sinem Saar, Ayşegül Yıldız, Emine Yıldırım, Recep Uyar, Yağmur Turgut-Birer, Begüm Yurdakok-Dikmen, Füsun Acartürk
Journal of Pharmaceutical Innovation.2026;[Epub] CrossRef
Habitat heterogeneity analysis of planning CT improves the prediction of radiation proctitis in cervical cancer: A multimodal machine learning study
Shuai Zhang, Dingli Ye, Yuting Xiu, Haifeng Liu, Fanxu Meng, Xinmin Zhang, Zhicheng Wang, Hong Yu, Yufei Han, Xi Chen, Baosheng Sun
Applied Radiation and Isotopes.2026; 236: 112763. CrossRef
Unraveling Radiation Enteritis: Oxidative Stress as a Central Driver and Therapeutic Target
Pengfei Zhong, Zhiyuan Li, Zhenjun Pu, Hongyu Nian, Junliang Li
Antioxidants & Redox Signaling.2026;[Epub] CrossRef
Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis
Jae Seung Kim, Jaram Lee, Hyeung-min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Cancers.2024; 16(24): 4280. CrossRef

Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model: Mani Habibi, Osman Zekai Oner, Mehmet Tahir Oruc, Nurullah Bulbuller, Sebahat Ozdem, Sukru Ozdemir, Arsenal Sezgin Alikanooglu, Rojbin Karakoyun, Ugur Dogan, Ayper Ongen, Umit Koc; Ann Coloproctol. 2015;31(6):213-221. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.213

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Abstract PDF

Purpose

Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model.

Methods

Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis.

Results

Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined.

Conclusion

Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.

Citations

Citations to this article as recorded by

Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study
Gang Tang, Feng Pi, Zhengqiang Wei, Xiangshu Li
Nutrition and Cancer.2023; 75(4): 1254. CrossRef
Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study
Gang Tang, Feng Pi, Yu-Hao Qiu, Zheng-Qiang Wei
Frontiers in Nutrition.2023;[Epub] CrossRef
The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model
Afag Aghayeva, Cigdem Benlice, Ismail Ahmet Bilgin, Pinar Atukeren, Gulen Dogusoy, Figen Demir, Deniz Atasoy, Bilgi Baca
Tumori Journal.2017; 103(3): 307. CrossRef
Topical Effect of Glutamine for Colorectal Anastomosis
Jong-Woo Kim
Annals of Coloproctology.2015; 31(6): 207. CrossRef

Case Reports

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation: Jalal Vahedian-Ardakani, Shahram Nazerani, Amir Saraee, Ali Sarmast, Ehsan Saraee, Mohammad Reza Keramati; Ann Coloproctol. 2014;30(6):285-289. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.285

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Abstract PDF

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Citations

Citations to this article as recorded by

Barium granuloma formation following barium peritonitis: A case report
Baiquan Zhou, Lin Liu, Yufan Tang, Ruifang Fan
Asian Journal of Surgery.2025;[Epub] CrossRef
Perforation of barium sulfate enterography in an infant: A case report
Yixing Lu, Lixian Mo, Junhong Chen, Wei Peng
Medicine.2024; 103(17): e37926. CrossRef
A Case of Sigmoid Colon Perforation Caused by Barium that was Treated by Laparoscopic Surgery
Shoichiro HARA, Junichi HAMADA, Kenichi TAKEMOTO, Kei NAITO, Toshiya OCHIAI, Eigo OTSUJI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2024; 85(4): 546. CrossRef
Barium sulfate

Reactions Weekly.2015; 1549(1): 45. CrossRef

A Case of Coffee Enema-induced Colitis.: Seo, Chan Hee , Kim, Young Ho; J Korean Soc Coloproctol. 2009;25(3):193-196.; DOI: https://doi.org/10.3393/jksc.2009.25.3.193

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3 Citations

Abstract PDF

A coffee enema, which has been suggested as a part of cancer treatment, is a hazardous derivative of colon therapy and has been misused as a treatment for obesity and constipation among the general population. Its proponents claim that caffeine is absorbed in the colon and leads to vasodilatation in the liver, which in turn enhances the process of elimination of toxins. None of this is proven, nor is there any evidence for the clinical efficacy of coffee enemas. We experienced a patient who presented with abdominal pain and bloody stool after receiving a coffee enema to relieve constipation. We report this case of coffee-associated colitis with a review of the relevant literature.

Citations

Citations to this article as recorded by

Proctocolitis From Coffee Enema
Anna H. Lee, Sohaip Kabashneh, Charles P. Tsouvalas, Usman Rahim, Mir Y. Khan, Mohammad Anees, Diane Levine
ACG Case Reports Journal.2020; 7(1): e00292. CrossRef
The safety and effectiveness of self-administered coffee enema
Heejung Son, Hyun Jin Song, Hyun-Ju Seo, Heeyoung Lee, Sun Mi Choi, Sanghun Lee
Medicine.2020; 99(36): e21998. CrossRef
Local Management of Constipation: Enemas, Suppositories
Seong-Eun Kim, Jeong Eun Shin, Kyoung Sup Hong, Tae Hee Lee, Bong Eun Lee, Seon-Young Park, Sung Noh Hong, Kee Wook Jung, Kyung Sik Park, Suck Chei Choi
Korean Journal of Medicine.2015; 88(1): 15. CrossRef

Original Article

Is Barium Enema Prior to Ileostomy Closure Necessary?.: Lee, Min Ro , Lee, Min Joo , Kim, Jong Hun , Hwang, Yong; J Korean Soc Coloproctol. 2006;22(5):298-300.

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Abstract PDF: PURPOSE
A barium enema is frequently performed to check for healing prior to ileostomy closure, but there have been reports that ileostomy closure without a contrast study is safe in selected patients. The aim of this study was to assess the necessity of a routine barium enema prior to ileostomy closure.
METHODS
Between January 1994 and June 2005, 51 patients with a temporary loop ileostomy who had a barium enema prior to ileostomy closure at Chonbuk National University Hospital were retrospectively reviewed. These patients were divided into 2 groups, the protective ileostomy group and the ileostomy-after-leakage group. To examine the necessity of a routine barium enema prior to ileostomy closure, we assessed whether the barium enema results changed management and whether there were pelvic sepsis and obstructive symptoms following ileostomy closure.
RESULTS
In the protective ileostomy group (n=39), the barium enema was performed after a mean of 59 days (range: 27~151 days). There were no abnormal findings at the barium enema, no schedule changes, no pelvic sepsis, and no obstructive symptoms following ileostomy closure. In the ileostomy-after-leakage group (n=12), the barium enema was performed after a mean of 54 days (range: 30~82 days). In 2 patients, with barium enemas at 33 days and 36 days, an anastomotic leakage was found, and ileostomy closure was delayed.
CONCLUSIONS
In patients with a protective ileostomy, a barium enema prior to ileostomy closure is unnecessary, but in patients with an ileostomy after leakage, barium enema should be considered.

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