A Case of Ischemic Colitis Presenting as Bloody Diarrhea after Glycerin Enema

Yoon, Jong Min; Kim, Sang Hyun; Lee, Jin Sook; Kim, Min Jung; Jang, Se Won; Kim, Yang Jin; Jeon, Tae Young

doi:10.5217/ir.2013.11.1.52

Cited by 2 publications

(3 citation statements)

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“…Park et al [ 14 ] reported a case of IC that occurred within 2 h of normal saline enema for preoperative bowel cleansing. Most recently, Yoon et al [ 15 ] reported a case of IC that presented abdominal pain and hematochezia within 30 min of enema administration. Our data suggest that it may be necessary to observe patients receiving glycerin enema in the early period after administration (at least 4 to 8 h), considering timing of IC and high surgical resection rates.…”

Section: Discussionmentioning

confidence: 99%

“…The exclusion criteria were as follows: (1) Patients with unspecific vascular hypoperfusion or its similar condition ( e.g ., cardiac failure, septic shock, hemodynamic shock, hemodialysis, and aortic surgery), colonic obstruction (volvulus, adhesion, stricture, hernia, colon cancer, or metastasis), vascular occlusion (based on the findings of follow-up CTs performed after enema), and infectious or inflammatory bowel disease ( e.g. , inflammatory bowel disease, radiation colitis, and infectious colitis); and (2) Time interval from enema administration to IC occurrence of > 24 h based on the prior case reports[ 13 - 15 ]. Among 17087 adult patients receiving enema in the ED, 542 patients were excluded due to infectious or inflammatory bowel disease ( n = 123), colonic malignancy ( n = 283), and mechanical ileus ( n = 136).…”

Section: Methodsmentioning

confidence: 99%

“…The existence of a relationship between IC and enema administration has been suggested in the literature. Several case reports have reported IC following enema administration for the treatment of constipation, preoperative bowel cleansing and the correction of hyperkalemia[ 12 - 15 ]. Therefore, in some studies, enema administration has been considered to be a risk factor for the development of IC[ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Ischemic colitis after enema administration: Incidence, timing, and clinical features

Ahn

Hong

Lee

et al. 2020

WJG

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BACKGROUND Enema administration is a common procedure in the emergency department (ED). However, several published case reports on enema-related ischemic colitis (IC) have raised the concerns regarding the safety of enema agents. Nevertheless, information on its true incidence and characteristics are still lacking. AIM To investigate the incidence, timing, and risk factors of IC in patients receiving enema. METHODS We consecutively collected the data of all adult patients receiving various enema administrations in the ED from January 2010 to December 2018 and identified patients confirmed with IC following enema. Of 8320 patients receiving glycerin enema, 19 diagnosed of IC were compared with an age-matched control group without IC. RESULTS The incidence of IC was 0.23% among 8320 patients receiving glycerin enema; however, there was no occurrence of IC among those who used other enema agents. The mean age ± standard deviation (SD) of patients with glycerin enema-related IC was 70.2 ± 11.7. The mean time interval ± SD from glycerin enema administration to IC occurrence was 5.5 h ± 3.9 h (range 1-15 h). Of the 19 glycerin enema-related IC cases, 15 (79.0%) were diagnosed within 8 h. The independent risk factors for glycerin-related IC were the constipation score [Odds ratio (OR), 2.0; 95% confidence interval (CI): 1.1-3.5, P = 0.017] and leukocytosis (OR, 4.5; 95%CI: 1.4-14.7, P = 0.012). CONCLUSION The incidence of glycerin enema-related IC was 0.23% and occurred mostly in the elderly in the early period following enema administration. Glycerin enema-related IC was associated with the constipation score and leukocytosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ischemic colitis after enema administration: Incidence, timing, and clinical features

Ahn

Hong

Lee

et al. 2020

WJG

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Local Management of Constipation: Enemas, Suppositories

et al. 2015

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The treatment for constipation should be individualized and dependent on the cause, coexisting morbidities, and patient's cognitive status. Although most cases of constipation respond to conservative treatment, including dietary and life-style changes, or mild laxatives, some patients still complain of consistent symptoms and need an assessment of defecatory dysfunction. There is insufficient evidence to support the use of enemas in chronic constipation, although many clinicians and patients find them useful and effective for the treatment of fecal impaction when used with other modalities. In addition, suppositories can be considered as an initial trial for the treatment of defecatory dysfunction, since they help to initiate or facilitate rectal evacuation. The routine use of enemas is typically discouraged, especially sodium phosphate enemas, although tap-water enemas seem safe for more regular use. Soapsuds enemas are not recommended due to possible rectal mucosal damage.

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A Case of Ischemic Colitis Presenting as Bloody Diarrhea after Glycerin Enema

Cited by 2 publications

References 5 publications

Ischemic colitis after enema administration: Incidence, timing, and clinical features

Ischemic colitis after enema administration: Incidence, timing, and clinical features

Local Management of Constipation: Enemas, Suppositories

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