Chemical Colitis From a Hydrogen Peroxide Enema

Abstract

Constipation is one of the most common complaints among patients. Many resort to “natural” therapies described by complimentary and alternative medicine. Hydrogen peroxide enemas, ranging from 3-10% solutions, are one of the promoted remedies. We present a case of chemical colitis after using a hydrogen peroxide enema. A 26-year-old female with chronic constipation, presented with bright red blood per rectum for 2 days. It started immediately after using a 35% hydrogen peroxide enema for constipation. She had used herbal enemas previously, and this was the first time she had used hydrogen peroxide. She had large-volume rectal bleeding with fresh blood that quickly slowed down. She had abdominal pain with vomiting, decreased appetite, and tenesmus. Initial assessment revealed an afebrile, normotensive young woman, with diffuse abdominal tenderness most severe in the left lower quadrant, without rebound tenderness or rigidity. Laboratory evaluation was significant for leukocytosis (17.09 x 103/μL) and slightly elevated C-reactive protein (3.0 mg/dL). Her hemoglobin was normal on presentation 12.8 g/dL. Fecal calprotectin was greater than 1250 μg/g with fecal leukocytes present. Her lactic acid was within normal limits. Computed tomography of the abdomen and pelvis revealed diffuse left transverse and left colonic thickening and submucosal edema up to the mid-transverse colon, suggestive of colitis (Image 1). She was admitted and was managed conservatively with intravenous hydration, electrolytes correction, serial abdominal examinations, and hemoglobin checks. Colonoscopy was deferred due to risk of perforation. Rectal bleeding stopped after 3 days; she clinically improved with supportive care only. The patient was discharged and advised to avoid chemical enemas in the future. At a 3-month follow up, she denied any episodes of rectal bleeding. There are a few reported cases of chemical-induced colitis in patients experimenting with hydrogen peroxide enemas to self-treat chronic constipation. Hydrogen peroxide enemas are an increasing “home remedy” that are made popular on alternative medicine websites. The production of hydroxyl free radicals from hydrogen peroxide causes cell death. Macroscopically, it leads to corrosive injury of the colonic mucosa. With increasing availability of information on the Internet, it is critical to caution and inform patients of potentially dangerous therapies that are not medically approved.Figure: Diffuse submucosal edema up to mid-transverse colon, suggestive of colitis.