Caustic burns of rectum and colon in emergencies

A Caustic Hydrochloric Acid Enema: A Case Report

Rectitis caused by the administration of a caustic enema is uncommonly encountered in routine clinical practice. The reasons given for the application of caustic enemas are diverse, including but not limited to suicide attempts, murder attempts, iatrogenic causes and simple mistakes. When caustic enemas do occur the consequences can be dire, resulting in extensive injury. These injuries often prove fatal in the short term, but if the patient survives the initial injuries, they may subsequently cause severe disability. Treatment can be conservative but commonly involves surgery, with a significant proportion of patients not surviving the intervention or succumbing to complications thereafter. We present the case of a patient with a history of alcoholism, depression and a recent recurrence of oesophageal cancer who self-administered a hydrochloric acid enema in an attempted suicide. The patient subsequently suffered a stenosis of the lower bowel, resulting in diarrhoea. A colostomy was performed in order to alleviate the patient's symptoms and improve their comfort.

Intractable rectal stricture caused by hot water enema

Rectal burns caused by hot water enema have been reported only occasionally and the majority of them were treated in a conservative manner. Although intractable rectal stricture caused by rectal burn is rare, it may be treated by endoscopic intervention or surgery. A 52-year-old woman who had used various methods of enema to treat her chronic constipation eventually undertook a hot water enema herself. After that, anal pain and constipation became aggravated prompting her to visit our clinic. Although various nonoperative treatments including endoscopic stenting were performed, her obstructive symptom did not improve and endoscopic findings had not changed. Hence, we performed a laparoscopic proctosigmoidectomy and transanal coloanal anastomosis with ileal diversion to treat the disease, and as a result, her obstructive symptom improved well. Corrective surgery such as resection of involved segment with anastomosis may be beneficial in relieving obstructive symptoms of an intractable rectal stricture caused by hot water enema.

Chemical Burns and Multiorgan Failure following Acute Ingestion of White Spirit: A Case Report and Review of the Literature

Organic solvents are chemically different compounds with one common feature: they dissolve fats, oils and resins, which makes them widely used in industry. Organic solvents are used in paint and lacquer industries, in the production of pesticides, plastics, explosives and in the pharmaceutical industry. The most common household solvent is white spirit, used as a paint remover. We report a case of acute white spirit ingestion causing multiorgan failure and a prolonged intensive care unit admission. Such a case has not been documented previously and highlights a number of diagnostic and therapeutic considerations. The patient also represents the first reported case of chemical burns from erosive diarrhoea secondary to white spirit ingestion.

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.

Updates on the Evaluation and Management of Caustic Exposures

In 2004, the American Association of Poison Control Centers' Toxic Exposure Surveillance System documented over 200,000 exposures to caustic substances, in both household and industrial products. Although the most commonly affected body areas are the face, eyes, and extremities, all reported fatalities were as a result of ingestion. Little controversy exists in patient management following dermal or ocular caustic exposure. Immediate water irrigation of the site of caustic exposure, followed by routine burn care, analgesia, intravenous fluids, and electrolyte replacement are standards of care. In this manuscript, a thorough review of the management of gastrointestinal caustic exposure is explored, not only because of the high rates of morbidity and mortality associated with these exposures, but also because there remains controversy regarding appropriate management of such exposures. Hydrofluoric acid, a weak acid in its aqueous form, requires special consideration and specific antidotes, and as such, is addressed separately.