Colonic Mucosal Pseudolipomatosis: Disinfectant Colitis with Hydrogen Peroxide

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Backgrounds: Pseudolipomatosis is recently described rare colonoscopic finding with whitish foamy mucosal plaques. Pathogenesis is unknown, but mechanical traumatic injury to mucosa during endoscopic procedure, intramucosal air such as pneumatosis coli, or chemical injury by disinfectant seems to contribute to its pathogenesis. We observed eight cases of colonic pseudolipomatosis during three months only after changing endoscopic disinfectants from glutaraldehyde to peracetic acid (SCOTELIN¢ç; compounds of hydrogen peroxide with radical oxygen bactericidal effect). Therefore we thought that endoscopic disinfectant such as SCOTELIN¢ç seemed to be more possible cause of pseudolipomatosis than mechanical traumatic injury or intramucosal air. The aim of our study was to determine the effect of disinfectant as a major cause of pseudolipomatosis. Methods: We experimentally attempted to induce mucosal pseudolipomatosis by alcohol, SCOTELIN¢ç or 3% hydrogen peroxide in pig gut. All specimens were stained with periodic acid-Schiff, alcian blue or mucicarmine to exclude mucin droplet and Oil Red O to exclude fatty infiltration. We compared specimens of the eight patient cases diagnosed to pseudolipomatosis with the three cases of experimental pig gut specimen artificially induced by disinfectants such as alcohol, SCOTELIN¢ç or 3% hydrogen peroxide. Results: The specimens of eight patient cases showed multiple aggregations of small air spaces resembling fatty infiltration in lamina propria. These findings were also seen at the three specimens of pig gut cases induced by SCOTELIN¢ç and hydrogen peroxide, but were not seen at the specimens of pig gut cases induced by alcohol. Staining with periodic acid-Schiff, alcian blue, mucicarmine, or Oil Red O did not show such findings. Conclusions: Although our study has a limitation of small sample size, these results suggest that endoscopic chemical disinfectants with hydrogen peroxide appeare more important to intestinal mucosal injury than air-pressure related mechanical injury during colonoscopy. Forced air drying and an additional preprocedure rinse of channels and the exterior of the scope should ensure a chemical-free examination. Backgrounds: Pseudolipomatosis is recently described rare colonoscopic finding with whitish foamy mucosal plaques. Pathogenesis is unknown, but mechanical traumatic injury to mucosa during endoscopic procedure, intramucosal air such as pneumatosis coli, or chemical injury by disinfectant seems to contribute to its pathogenesis. We observed eight cases of colonic pseudolipomatosis during three months only after changing endoscopic disinfectants from glutaraldehyde to peracetic acid (SCOTELIN¢ç; compounds of hydrogen peroxide with radical oxygen bactericidal effect). Therefore we thought that endoscopic disinfectant such as SCOTELIN¢ç seemed to be more possible cause of pseudolipomatosis than mechanical traumatic injury or intramucosal air. The aim of our study was to determine the effect of disinfectant as a major cause of pseudolipomatosis. Methods: We experimentally attempted to induce mucosal pseudolipomatosis by alcohol, SCOTELIN¢ç or 3% hydrogen peroxide in pig gut. All specimens were stained with periodic acid-Schiff, alcian blue or mucicarmine to exclude mucin droplet and Oil Red O to exclude fatty infiltration. We compared specimens of the eight patient cases diagnosed to pseudolipomatosis with the three cases of experimental pig gut specimen artificially induced by disinfectants such as alcohol, SCOTELIN¢ç or 3% hydrogen peroxide. Results: The specimens of eight patient cases showed multiple aggregations of small air spaces resembling fatty infiltration in lamina propria. These findings were also seen at the three specimens of pig gut cases induced by SCOTELIN¢ç and hydrogen peroxide, but were not seen at the specimens of pig gut cases induced by alcohol. Staining with periodic acid-Schiff, alcian blue, mucicarmine, or Oil Red O did not show such findings. Conclusions: Although our study has a limitation of small sample size, these results suggest that endoscopic chemical disinfectants with hydrogen peroxide appeare more important to intestinal mucosal injury than air-pressure related mechanical injury during colonoscopy. Forced air drying and an additional preprocedure rinse of channels and the exterior of the scope should ensure a chemical-free examination.