UCTN nnnnnnnnnnnnnnnnnnnnnnnnnn Unusual Cases and Technical Notes 641

Accidental Intrarectal Administration of Alcohol Enema Induces Proctocolitis and Fecal Incontinence

At 2 hours before an elective colonoscopy indicated for abdominal pain in a 67-year- old woman, the patients sister wrongly administered 250 cm3 of ªcleansing ene- maº containing ethyl alcohol 96%. The patient experienced a perineal and anorec- tal burning pain, severe abdominal pain, profuse and involuntary diarrhea, tenes- mus, rectal bleeding, and the emission of numerous white plaques mixed with and all over the liquid feces. We diagnosed a Figure 1 Colonoscopy revealed confluent Figure 2 Proximal rectal mucosa showed a white plaques adherent to underlying distal rectal severe erythema and mucosal denudation, prob- severe colonic mucosal sloughing with a mucosa and covering partially the anal canal and ably as a result of the rectal bleeding and the possible secondary perforation. A conser- perianal epidermis. The fecal incontinence was detachment of fibrin white plaques overlying a vative treatment was prescribed of intrave- extremely severe, and occurring when the pa- few hours before nous fluids and electrolytes, and intrave- tient was upright nous cefotaxime, metronidazole, and anal- gesics. We had no evidence-based reasons cleansing enema. We think endoscopic 3 Herrerias JM, Muniain MA, Sanchez S, to prescribe her steroids, so we treated our follow-up should not take place until at Garrido M. Alcohol-induced colitis. En- patients acute proctocolitis as an ischemic least 3 weeks after alcohol instillation, as a doscopy 1983; 15: 121±122 colitis. perforation could occur if a colonoscopy is 4 Bhalotra R. Alcohol-induced proctitis in done with normal insufflation. Our case a human. J Clin Gastroenterol 1988; 10: After 24 hours, we performed a careful shows the endoscopic features and clinical 592 flexible colonoscopy +Figures 1 and 2). For manifestations of alcohol-induced func- 5 Triantafillidis JK, Vekini J, Nicolakis D, the next 7 days, the patient improved with tional and structural damage to the anus, Emmanouilides A. Ethanol-induced less abdominal pain, lack of peritonism rectum and colon, with complete resolu- proctitis: another kind of chemical proc- signs and no bleeding, the diarrhea stopped tion after conservative treatment. titis. Am J Gastroenterol 1994; 89: and she was able to eat and move almost 1270 ±1271 normally. She continued outpatient treat- M. Rodriguez-Tellez 1, J. M. Herrerias Jr., ment comprising of oral antibiotics for a F.Argüelles, M. J. Gonzalez-Mariscal, further 7 days. Fecal incontinence was the F.J. Pellicer 1, J. M. Herrerias Corresponding Author last symptom to disappear, by the 3rd 1 Endoscopy Unit, Division of Digestive Dr. M. Rodriguez-Tellez week. Diseases, Virgen Macarena University C/Rafael Belmonte Garcia Hospital of Seville, Spain 4 Puerta 8 A month later, when she was symptomless, Sevilla 41010 we performed a total colonoscopy and References Spain observed only a mild patchy erythema on Fax: + 34-955-008805 rectal and sigmoid mucosa, no white 1 Jonas G, Mahoney A, Murray J, Gertler E-mail: mrodrigueztellez@ plaques, no stenosis, and many small S. Chemical colitis due to endoscope medynet.com noncomplicated colon diverticula mainly cleaning solutions: a minic of pseudo- distributed in the sigmoid colon. At the last membranous colitis. Gastroenterology visit, 1 year later, the patient was comple- 1988; 95: 1403 tely asymptomatic and there were no 2 Davila AD, Willenbucher RF. Other dis- inflammatory features at colonoscopy. eases of the colon and rectum: melanosis coli, cathartic colon, and soap or chemi- Acute colitis has been described after cal colitis. In: Feldman M, Sleisenger rectal instillation of detergent or chemical MH, Scharschmitt B +eds). Sleisenger substances [1,2]. This is the fourth case and Fordtrans gastrointestinal and liver reported in medical literature referenced in disease. Philadelpha: Saunders, 1998: Medline of alcohol-induced proctitis in- 1992 ±1995 volving ethyl alcohol [3±5]. Our case is the first to describe fecal incontinence that occurred as the result of an accidental ethyl alcohol enema administered prior to an elective colonoscopy.

It is possible that these accidental instilla- tions occur more frequently in clinical practice but to a less severe degree, probably because patients notice perineal burning initially and quickly remove the