Acid burns of the rectum and colon. Report of a case

Chemical colitis

Chemical colitis can occur as a result of accidental contamination of endoscopes or by intentional or accidental administration of enemas containing various chemicals. Most cases have occurred after accidental contamination of endoscopes with glutaraldehyde and/or hydrogen peroxide. There have been multiple case reports of chemical colitis resulting from unintentional administration of caustic chemicals. Intentional administration of corrosive enemas has been implicated in sexual practices, bowel cleansing, or in suicide attempts. Patients present with nonspecific symptoms including abdominal pain, rectal bleeding, and/or diarrhea. As chemical colitis remains rare, the literature consists of scattered case reports and small series. Agents implicated in chemical colitis that are covered in this review include alcohol, radiocontrast agents, glutaraldehyde, formalin, ergotamine, hydrofluoric acid, sulfuric acid, acetic acid, ammonia, soap, sodium hydroxide, hydrogen peroxide, herbal medicines, chloro-m-xylenol, and potassium permanganate. Clinical, endoscopic, and histologic features are outlined for each agent in addition to the existing literature. Given the nonspecific presentation of many cases of chemically induced colitis, the diagnosis can be challenging if the pertinent history is not obtained. Most patients demonstrate the resolution of chemical-induced colitis after conservative or medical therapy. Depending on the depth and extent of injury, patients rarely require colectomy for ischemic colitis and/or peritonitis. Other postingestion complications include colonic strictures and rectovaginal fistulae. The benefits of medical therapy compared with conservative therapy are not known, as comparative clinical management trials have not been performed.

Caustic burns of rectum and colon in emergencies

BACKGROUND

Because of their rarity, chemical burns of rectum and colon have been poorly studied. This clinical report studies the epidemiologic, diagnostic, and therapeutic features of rectal and colonic burns after enema with caustics.

METHODS

This is a retrospective clinical report of a personal series of 21 patients admitted in our hospital from January 1990 to January 2000 for an acute chemical colitis after enema.

RESULTS

Inpatient prevalence: 0.04%. Mean age: 29.7 +/- 12 years (range 17 to 19). Sex ratio: 16 female and 5 male. Circumstances: suicide (n = 14), abortion (n = 3), murder (n = 3), mistake (n = 1). Responsible caustic: sulphuric acid (n = 12), chlorhydric acid (n = 5), potash (n = 2), unknown acid (n = 1), plant decoction (n = 1). Injected quantity: 50 to 250 mL. Ten patients suffered light damage and had an early favorable course under medical treatment, 8 of them had a secondary rectal-sigmoid stenosis. Eleven patients presented with severe necrotic damage, of difficult and often delayed diagnosis based on an enduring symptomatology without clear peritoneal syndrome. Upon surgery, necrotic damage spread on rectum and sigmoid colon (n = 2), up to the transverse colon (n = 4), to the right colonic angle (n = 3), to the right colon (n = 2); once a 10 cm long necrosis of the ileum was associated (n = 1); only 1 patient had a colonic perforation. Performed surgery: 11 resections of necrotic colon and proximal colostomy (Hartman operation). Mortality: 6 patients. Morbidity: 3 of 5 patients.

CONCLUSIONS

Chemical burns of rectum and colon produced by strong acid or basic products are necrotizing lesions whose gravity is often hidden by the absence of peritoneal inflammation signs, thus mortality is high. Only early surgery is likely to improve the poor prognosis of severe chemical damage of the rectum and colon.

Burns of the female genitalia and perineum

Burns of the female genitalia and perineum mostly occur in connection with more extensive thermal injuries to the trunk and lower extremities. Isolated burns to the vulva are very unusual because this area is anatomically well-protected. A few reports in the literature describe injuries due to bizarre accidents and now obsolete techniques. The management of these injuries, possible complications, prognosis and long-term results are discussed following a case report of a 28-year-old woman who sustained extensive deep dermal burns to her external and internal genitalia in a suicide attempt involving a firework.

Iatrogenic and accidental colon injuries--what to do?

PURPOSE

This study was designed to formulate management guidelines for a variety of rare iatrogenic and accidental injuries to the colon and rectum.

METHODS

This review collates the available evidence in the literature.

RESULTS

Both investigative and therapeutic maneuvers involving the colon, particularly endoscopy and radiographic contrast studies, are the most common cause of significant injury although the incidence is low. Even less common are injuries produced, at open surgery and minimally invasive surgery, by foreign bodies, enemas, or compressed air. The mechanisms and management of these injuries are discussed in detail.

CONCLUSIONS

Evidence exists to support that a nonoperative approach is safe for the majority of injuries, particularly when the colon is "clean" at the time of injury. Adequate resuscitation, observation, and repeated reassessment are mainstays of a conservative policy. Operation is essential for progression of abdominal signs. Patients with established peritonitis at the time of presentation or with an unprepared bowel are best served by prompt operation.

Acetic acid intoxication by rectal administration

The enhanced toxicity of acid instilled directly into the rectum, without benefit of dilution and neutralization in the upper intestine, is evident in a case of acetic acid intoxication by accidental rectal administration of 50 mL of 9% acetic acid to a 5-year-old boy. The complications included necrosis of the colon, acute renal failure, acute liver dysfunction, disseminated intravascular coagulopathy (DIC) and sepsis.