Assessment of proctitis

The presence of fever, abdominal tenderness, and guarding in the setting of suspected proctitis is a red flag and indicates more extensive colonic involvement by inflammation or infarction.

Massive rectal bleeding from proctitis may occur due to necrosis or ulceration around blood vessels, and has been described with ischaemic, radiation, and ulcerative proctitis. Patients presenting with this complication may require urgent endoscopic or angiographic measures for haemostasis. Supportive measures such as intravenous access, fluid resuscitation, and intensive care unit (ICU) monitoring would be required in this setting. In patients with severe idiopathic ulcerative proctitis, intravenous steroids may be required to treat the rectal inflammation.

Ischaemic proctitis may cause infarction of the rectal wall, perforation, and sepsis in rare cases.[6]Sharif S, Hyser M. Ischemic proctitis: case series and literature review. Am Surg. 2006 Dec;72(12):1241-7. http://www.ncbi.nlm.nih.gov/pubmed/17216829?tool=bestpractice.com ​ These complications would require surgical and ICU management.