This is a 79-year-old woman with a history of hypertension, osteoporosis and hysterectomy for myomatosis at the age of 50. She underwent transurethral resection of infiltrating bladder carcinoma in October 2006. She subsequently received radiotherapy sessions up to a total of 50 Gy due to persistence of an external tumour mass in the right angle of the bladder, finishing this treatment in June 2007. In August 2007 she began chemotherapy treatment due to persistence of the bladder lesion and metastases in the spine detected by follow-up CT scan and bone scintigraphy. Her digestive history began in February 2008 when she was admitted for episodes of rectorrhagia, initially scarce and distal, but which soon became more frequent and profuse, accompanied by symptoms of haemodynamic instability and severe anaemia with extensive transfusion requirements.
Total colonoscopy was performed, showing only changes typical of actinic proctitis with large friable and bleeding neovascular lesions; treatment was carried out with argon plasma (APC). The patient's clinical course was unfavourable: she received consecutive treatment with steroid enemas, 5-aminosalicylic acid and sucralfate; in addition, three more therapeutic rectoscopies were performed, applying APC treatment, despite which the episodes of profuse rectorrhagia with haemodynamic instability persisted, requiring transfusion of a total of 21 red blood cell concentrates throughout the patient's hospitalisation period, despite also receiving oral and intravenous ferrotherapy.
In the absence of response to these treatments, the case was discussed with the surgeon for topical treatment with formalin, who, using spinal anaesthesia and anal dilatation, treated the rectal ampulla for 10 minutes with a 10% formalin solution 200 ml + 300 ml of water; The patient's tolerance to the procedure was excellent, it was carried out without any complications and from that moment onwards the patient was completely asymptomatic without new episodes of haemorrhagic externalisation, haemodynamic instability or new transfusion requirements; she was discharged and a follow-up colonoscopy was proposed after the treatment, but she did not accept.
Four months later, she was admitted again for clinical signs of tumour progression, and symptomatic treatment was decided by the Oncology Department, and the patient died, but without recurrence of the rectorrhagia.