P3513 - A Case of Rectal Bleeding From Ulcer Secondary to Erosion of SpaceOAR Gel Into the Rectal Wall

Chaudry N. Majeed, MBBS¹, Ahmad Bilal, MBBS², Jennifer Dziwis, MD³, Joel Bruggen, MD^3
1Wake Forest Baptist Health, Winston-Salem, NC; ²M. Islam Medical & Dental College, Gujranwala, Punjab, Pakistan; ³Wake Forest School of Medicine, Winston-Salem, NC

Introduction: Radiotherapy is an important component of prostate cancer management; however, it carries the risk of inadvertently exposing rectal tissue to radiation. The insertion of SpaceOAR hydrogel in the space between the prostate and the rectum has been shown to reduce the risk of toxicity to the rectum. There is a rarely reported complication of rectal ulceration following SpaceOAR hydrogel insertion that gastroenterologists should be aware of such that it can be identified endoscopically.

Case Description/Methods: A 79-year-old male with h/o coronary artery disease on aspirin 81 mg daily and recently diagnosed prostate cancer on radiation therapy presented with rectal bleeding. Two weeks prior to presentation, the patient had a SpaceOAR hydrogel placed. After 3 consecutive days of radiation, he presented with two days of progressive rectal bleeding which he described as bright red with small clots. He reported associated rectal pain, loose stools, and occasional lightheadedness. Vitals were stable with blood Pressure 155/83 and heart rate 76. On rectal examination, an irregularity was palpated along the right anterior rectal wall. On labs, hemoglobin was 13.6 and coagulation profile was normal. Colonoscopy revealed a 1 cm non-bleeding ulcer with surrounding erythema along the right anterior rectal wall and adherent/protruding yellow-colored material. The ulcer corresponded to the location of the injected polymer material visible on the post- hydrogel injection Computed Tomography. Based on endoscopic appearance, it was determined that the bleeding was secondary to the SpaceOAR gel eroding into the rectal wall leading to the development of an ulcer. The patient was given a break from radiotherapy for six-weeks and with conservative management, this ulcer healed with successful resumption of radiation thereafter.



Discussion: To decrease the area of rectum receiving high dose radiation therapy for prostate cancer, trans-perineal injection of hyaluronic acid spacer is performed in into perirectal fat. In our case, the SpaceOAR gel invaded into the rectal wall causing ulceration and significant hematochezia. To avoid such injury, patients should receive periprocedural antibiotics and the spacer should be placed under ultrasound guidance. Once characteristic findings of SpaceOAR induced ulceration and bleeding are identified, a break from radiation therapy should be advised. The gel is intended to spontaneously dissolve which should be followed by eventual healing of the ulcer in 6-12 weeks.



Disclosures:


Chaudry N. Majeed, MBBS¹, Ahmad Bilal, MBBS², Jennifer Dziwis, MD³, Joel Bruggen, MD³. P3513 - A Case of Rectal Bleeding From Ulcer Secondary to Erosion of SpaceOAR Gel Into the Rectal Wall, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.