1663 Do Not Risk Your Colon: Beware of Hydrogen Peroxide Enema

Abstract

INTRODUCTION: Hydrogen peroxide is an oxidizing agent widely available in a variety of medical and household products. There are few reported cases of chemical colitis due to hydrogen peroxide enema used for constipation. We present an interesting case of chemical colitis due to hydrogen peroxide enema used by the patient for alcohol detoxification after reading on the internet. CASE DESCRIPTION/METHODS: A 33-year-old male with a history of alcohol abuse presented with complains of abdominal pain and hematochezia that started after self-administration of enema with 3% hydrogen peroxide diluted with saline for alcohol detoxification. On the abdominal exam, he had left lower quadrant tenderness. Vital signs were stable. CBC revealed mild anemia with hemoglobin (Hb) of 13 g/dl while BMP was unremarkable. CT scan of abdomen and pelvis showed mucosal thickening, edema and subtle pericolonic stranding changes of the rectosigmoid colon to proximal descending colon and no free air. Gastroenterology was consulted and the patient underwent flexible sigmoidoscopy which showed diffuse moderate inflammation in the rectum, sigmoid colon, descending colon and splenic flexure secondary to colitis. The patient was managed conservatively with bowel rest, fluid resuscitation and empiric antibiotics. Hemoglobin remained stable and he was discharged once he was able to tolerate diet and his symptoms resolved. DISCUSSION: Chemical colitis is the inflammation of the large intestine caused due to chemicals introduced into the colon after accidental contamination of endoscopes or administration of enemas containing various chemicals like hydrogen peroxide. Hydrogen peroxide produces highly reactive oxygen radicals which damages colonic mucosa. Diagnosis can be challenging if pertinent history is not obtained as patients with chemical colitis present with non-specific GI symptoms that mimic inflammatory colitis. Given readily availability of hydrogen peroxide and information on the internet to the public, patients should be educated about the dangers of hydrogen peroxide enema. Physicians should also be aware of these dangerous and life threatening ways their patients can attempt to relieve constipation or detoxification. It is very important to recognize this entity as it is entirely preventable.