C0151 - Common Household Item as an Unusual Etiology of Bowel Perforation

Usama Abu-Heija, MBBS¹, Rami Dalbah, MD¹, Omar Al Ta'ani, MBBS², Mohammad Darweesh, MD¹, Venkata Vedantam, MD^1
1East Tennessee State University, Johnson City, TN; ²King Hussein Cancer Center, Amman, 'Amman, Jordan

Introduction: Colonic perforation is defined by full-thickness injury to the colon wall with various etiologies. Presentation can vary according to the etiology of perforation. Patients usually describe abdominal pain as either localized or generalized, depending on the extent of spillage of intestinal contents and degree of peritonitis. Bowel perforation severity can range from a simple and medically managed condition to a life-threatening surgical emergency. We present a case of colonic perforation from an unsuspected etiology.

Case Description/Methods: A 51-year-old male presented to the hospital complaining of proctalgia, and rectal bleeding which had started two hours after self-administering an enema at home. After symptom onset, the patient realized he erroneously had used bleach instead of his usual homemade rainwater enema that he regularly uses to relieve chronic constipation. On examination, the patient had severe abdominal and rectal tenderness with visible dried blood around the anus. A CT scan of the abdomen revealed moderate circumferential wall thickening involving the sigmoid colon and rectum (Figure 1, A), in addition to pneumoperitoneum within the mesenteric fat adjacent to the sigmoid colon (Figure 1, B). The surgical team assessed the patient and was deemed not a good surgical candidate. Medical management was recommended with NPO, analgesia, intravenous fluids, and antibiotics with subsequent improvement. Patient was discharged home after a few days following resolution of symptoms and extensive counseling.

Discussion: Sodium hypochlorite is the compound typically found in household bleach, primarily used for its antimicrobial properties for cleaning purposes. Typical household bleach is a strong alkaline with a pH of 11-13, and ingestion is associated with severe esophageal injury, with severity determined by the amount and concentration of the ingested compound. In addition, bleach enemas have been fraudulently marketed as a medical treatment for autism, with several reports of devastating outcomes in young children. This case demonstrates the gravity of using bleach enemas as medical treatment due to the potential for severe colitis and perforation, as seen in our patient.



Disclosures:


Usama Abu-Heija, MBBS¹, Rami Dalbah, MD¹, Omar Al Ta'ani, MBBS², Mohammad Darweesh, MD¹, Venkata Vedantam, MD¹. C0151 - Common Household Item as an Unusual Etiology of Bowel Perforation, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.