Résumé
Rectal tenesmus is a very uncomfortable symptom. Though antiarrhythmic drugs and nerve blocks have been proposed as a treatment for rectal tenesmus, none is well-established. We report a 68-year-old female who undertook surgery for uterine cervical cancer and underwent chemotherapy. She got a bilateral nephrostomy and bowel obstruction during the chemotherapy because of recurrence. She decided to stop chemotherapy and to receive palliative care. She had a symptom of rectal tenesmus, which was refractory to medications. The clinical sign was severe and uncomfortable, making her very nervous. We planned to treat the rectal tenesmus with a nerve block. A ganglion impar block was insufficient to remove the symptom, and the saddle block failed due to epidural lipomatosis. We finally succeeded in alleviating the sign with a neurolytic caudal epidural block. Relief of tenesmus made her hope to spend her final period at home. She could stay at home with her family for seven days before death without recurrence of the symptom. Though there is no report about the effectiveness of neurolytic caudal epidural block for rectal tenesmus, we consider the block appropriate for the symptom.
Résumé
Rectal irritative symptoms in cancer patients are often refractory to treat and exacerbate their quality of life. We experienced a peadiatric case of rectal irritative symptoms treated by Yokukansan. A 9 year-old boy developed rectal irritative symptoms as itching sensation in rectum caused by relapsed rhabdomyosarcoma in pelvis. Oral Yokukansan, which is common Japanese Kampo medicine for temper tantrum of children, was administered and relieved his symptoms. Yokukansan is known as adjuvant drug for neuropathic pain. It could be one of the adjuvant drugs for refractory symptoms in palliative care setting.
Résumé
Background: Although rectal tenesmus in patients with advanced cancer can have marked negative impact on quality of life, effective treatment has not yet been established. Case: A 71 -year-old man with an inoperable rectal cancer developed tenesmus 11 months after a colostomy. Tenesmus worsened over the following 3 months, and the patient suffered from involuntary straining every 5-15 minutes. After unsuccessful symptom control with radiotherapy to the primary lesion, we started oral amoxapine 25 mg that alleviated symptoms related to tenesmus. As the general condition deteriorated, however, oral intake became difficult. After the discontinuation of amoxapine, the tenesmus recurred even though intravenous administration of clomipramine was initiated. We started continuous infusion of intravenous lidocaine 200 mg/day which successfully relieved tenesmus. The dose of lidocaine was subsequently increased to 290 mg/day for worsening symptoms, which continued to control his distress caused by tenesmus until he died. Consideration/Conclusion: This is the first report that demonstrates the efficacy of oral amoxapine for rectal tenesmus with malignant tumor. After the discontinuation of amoxapine due to the inability of taking medications orally, symptoms remained under adequate control with infusional lidocaine until the patient died. Further studies are warranted to confirm our findings and to propose optimal use of medications in the management of rectal tenesmus.