Homemade colonic enema: Hot and oily

Abstract

A 67-year old woman with a major depressive disorder, urinary bladder incontinence and hypertension was brought to our emergency department with hematochezia and anal pain. Her complaints had begun five days before admission and after she had had a hot water mixed with olive oil enema for the relief of chronic constipation. She self administered and immediately evacuated the hot mixture. Lower abdominal discomfort ensued over the following hours and by the end of the first day, rectal bleeding and severe anal pain had appeared. These complaints worsened with time. On physical examination, she had a tender lower abdomen and an ulcerated lesion on the perianal skin. Her temperature was normal. Laboratory results revealed a white blood count -11 000 per mm3, hemoglobin -10.1 g/dL and C-reactive protein -14mg/dL (0--0.2mg/dL). Colonoscopy showed multiple ulcers interspersed with bluish nodular appearing mucosa in the rectum (Fig. 1). Histopathology was consistent with acute inflammation. Intravenous fluid therapy, bowel rest and analgesia were given for recovery. She was discharged on day three. On follow up colonoscopy, twomonth later, the