Robert Wood Johnson Medical School, Rutgers University New Brunswick, NJ, United States
Eric Zhao, MD, Abhishek Bhurwal, MD, Anish V. Patel, MD Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
Introduction: Chemical colitis is caused by the introduction of harsh chemicals to the colon by an enema or accidental contamination of endoscopes. Symptoms are nonspecific and can present like ulcerative colitis, infectious colitis, or ischemic colitis. Severe cases can result in bowel perforation and peritonitis.
Case Description/Methods: A 53-year-old African-American male with HTN presented with one day of lower abdominal pain, tenesmus, and bright red blood per rectum. He denied fevers, weight loss, nausea, and vomiting. Upon further questioning, he reported his symptoms occurred after use of a homemade hydrogen peroxide (HP) enema, using a recipe found on the Internet. In the emergency room, he was hypertensive and tachycardic, with leukocytosis and lactic acidosis. He had left lower quadrant tenderness on exam without peritoneal signs. Computerized tomography (CT) showed severe colitis involving the rectosigmoid colon (Figure 1) without perforation. No surgical intervention was performed. Flexible sigmoidoscopy was deferred given a concern for inducing perforation. He was treated with bowel rest, IV fluids and piperacillin-tazobactam. In the following days, the patient remained clinically stable. Leukocytosis and lactic acidosis resolved. Abdominal pain and hematochezia gradually improved, and he eventually tolerated a regular diet.
Discussion: We present here a case of chemical colitis due to HP. HP, widely used as a disinfecting agent, is often found in homeopathic remedies, particularly to achieve a laxative effect. Despite its theoretical benefits, HP can cause severe chemical colitis through direct caustic damage, oxygen free-radical formation, and lipid peroxidation.
Diagnosing chemical colitis can be challenging, as clinical presentation and radiologic features can be similar to other mechanisms of colitis. Therefore, obtaining a history that reveals the use of a chemical is key. A colonoscopy may not be necessary, as it may not change management. In HP-chemical colitis, the mainstay of management is conservative with bowel rest, IV hydration, and antibiotics. NSAIDs, corticosteroids, and mesalamine have not demonstrated any clinically proven benefits.
Overall, this case highlights the risks of HP and demonstrates the importance of taking a thorough history. Patients can be susceptible to potentially dangerous “therapies” advertised on the Internet. It is critical that physicians are aware of such therapies and are able to recognize these situations and manage them appropriately.
Figure: Figure 1. Thickening and submucosal edema of the rectosigmoid colon indicative of colitis.
Disclosures: Eric Zhao indicated no relevant financial relationships. Abhishek Bhurwal indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships.
Eric Zhao, MD, Abhishek Bhurwal, MD, Anish V. Patel, MD. P2244 - A Case of Chemical Colitis From a Hydrogen Peroxide Enema, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.