title: [Rectal tenesmus due to tumor invasion into the pelvic cavity responding favorably to antiarrhythmic drug therapy].
abstract: We experienced 3 patients(Cases 1, 3, and 4)with pelvic tumor-related rectal tenesmus showing favorable responses to antiarrhythmic drugs. Based on this experience, we administered antiarrhythmic drugs preferentially to 2 others with tumor derived rectal tenesmus(Cases 2 and 5), and again obtained favorable responses. These 5 patients(1 man, 4 women)were 28-89(mean 58)years of age. The primary lesion was cervical cancer in 3 patients, ovarian cancer in 1, and bladder cancer in 1. In the 3 with cervical cancer, the tumor had directly infiltrated the rectum and vulva. The patient with ovarian cancer had a residual tumor in the Douglas pouch postoperatively. The patient with bladder cancer had undergone total cystectomy and urinary diversion using an ileal conduit at another institution. All 5 patients complained of a frequent desire to defecate without feces(rectal tenesmus). Their rectal tenesmus was attributed to pelvic neurological dysfunction around the rectum. Drug therapy was initiated with oral mexiletine hydrochloride(Mexitil)150 mg in 3 divided doses in 4 patients and with continuous infusion of intravenous lidocaine 2%(Xylocaine)500mg/day in the other(Case 2). None had adverse reactions; all 5 experienced palliation of symptoms and improved quality of life.
authors.affiliation: Division of General Thoracic Surgery, Tokai University School of Medicine, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Yoshino
authors.forename: Takahisa
authors.initials: T
authors.lastname: Koizumi
authors.forename: Kenei
authors.initials: K
authors.lastname: Nakazato
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuda
authors.forename: Mikio
authors.initials: M
authors.lastname: Mikami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iwasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010386:Pelvic Neoplasms / Q000150:complications* / Q000473:pathology; D012002:Rectal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents