Rutgers New Jersey Medical School Newark, New Jersey
Introduction: Hydrogen peroxide was used for the management of meconium ileum and fecal impaction, and it was often used as a home remedy for constipation. Its use has now been abandoned due to harmful effects such as hydrogen peroxide-induced colitis, stricture, or perforation as an enema. We present a case of hydrogen peroxide-induced proctitis in a young male. Chemical-induced proctitis can mimic presentation of other conditions such as ulcerative colitis, pseudomembranous colitis, and ischemic colitis. Therefore, it signifies the importance of obtaining careful, pertinent history to make an accurate diagnosis in patients with unexplained proctitis.
Case Description/Methods: 30-year-old male with no significant past medical history presented with hematochezia and loose stool for 3 days. The patient was in his usual state until he used hydrogen peroxide enema with unknown concentration for constipation and he had anal intercourse afterwards. He started to experience multiple episodes of hematochezia, associated with tenesmus and loose stool in the following 2-3 days. The bleeding was associated with suprapubic and LLQ deep pain but no perianal pain. In the emergency room, vitals were stable, and CT showed proctitis and distal sigmoid colitis. He denied any similar symptoms in the past. He denied history for sexually transmitted diseases, perianal itching, discharge, perianal abscess, or fistula. He denied history of arthritis, skin rash or oral ulcers. Patient underwent sigmoidoscopy which showed severe, diffuse colitis seen in the distal rectosigmoid and in the rectum. Histopathological examination showed polypoid colonic mucosa with hyperplastic changes. Patient had clinical improvement with mesalamine enema.
Discussion: It’s unclear if anal intercourse after the administration of hydrogen peroxide is linked to pathogenesis of proctitis in this case. Clinical manifestations of hydrogen peroxide-induced proctitis range from self-limited colitis to strictures and perforation, which can lead to other serious complications. The pathogenesis is mainly from corrosive damage, secondary to penetration of the chemical with subsequent formation of oxygen. Most patients recover with conservative therapy. Endoscopic and CT findings of hydrogen peroxide-induced colitis can mimic pseudomembranous colitis, ulcerative colitis, and ischemic colitis, and therefore obtaining detailed, pertinent history is critical to make an accurate diagnosis.
