Hydrogen peroxide exposure mimicking ulcerative proctitis

Tas, Adnan; Aydın, Yasemin; Arhan, Mehmet; Köklü, Seyfettin

doi:10.1016/j.dld.2010.10.016

Cited by 9 publications

(3 citation statements)

References 3 publications

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“…Like other injury, the pathogenesis of hydrogen peroxide colitis is thought to be secondary to the chemical reaction resulting in penetration of highly reactive oxygen species, resulting in damage to the colonic mucosa [6,7]. The volume of oxygen liberated from the decomposition of hydrogen peroxide can be considerable, with 30 mL of 35% hydrogen peroxide yielding 3.5 L of oxygen, and it is thought to be secondary to absorption of hydrogen peroxide into the epithelial interstices and capillaries.…”

Section: Discussionmentioning

confidence: 99%

Chemical colitis caused by hydrogen peroxide enema in a child: case report and literature review

Lee

Yoo

2016

Environ Health Toxicol

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A 2-year-old girl, previously healthy, was brought to the emergency department because of significant cramping abdominal pain with recurrent hematochezia after an accidental hydrogen peroxide enema (35%, 5 mL) by her caregiver. She was hospitalized to the pediatric department and treated with nothing per mouth, intravenous fluid and parenteral antibiotic therapy. Laboratory, radiologic and endoscopic evaluation was performed during the admission period. She was discharged in a fully recovered state on the tenth hospital day, and this is the first case report of acute chemical colitis by accidental hydrogen peroxide enema in children.

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Section: Discussionmentioning

confidence: 99%

Chemical colitis caused by hydrogen peroxide enema in a child: case report and literature review

Lee

Yoo

2016

Environ Health Toxicol

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“…Endoscopy findings included wall thickening, mucosal friability, purulent exudates, diffuse and focal ulceration, gray, yellow/green pseudo-membrane formation, necrosis, and perforation of the distal colon or rectum [11]. On biopsy edema, congestion, hemorrhage of lamina propria, destruction of mucosal glands, "bubbly" appearance of goblet cells, ischemic changes, and micro-abscesses with polymorphonuclear leukocytes are seen [12][13].…”

Section: Discussionmentioning

confidence: 99%

Hydrogen Peroxide Enema-induced Proctitis in a Young Female: A Case Report

Mandzhieva

Khan

Rashid

et al. 2019

Cureus

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Hydrogen peroxide is a disinfectant commonly used for cleansing superficial wounds due to its oxidizing capacity. In the past, it has also been used for the management of meconium ileus in children as the oxidizing action of hydrogen peroxide potentiates peristalsis that relieves ileus or fecal impaction. The potential dangers were unknown till Pumphrey, in 1951, described the harmful effects of its use as an enema. We present a case of a 32-year-old female who was admitted for complaints of perianal pain. She used an enema, consisting of water and hydrogen peroxide, for constipation. It improved her symptoms but subsequently, she developed a burning sensation in her rectum. The patient had a colonoscopy which revealed severe proctitis up to 15 cm from the anal verge manifested by superficial mucosal ulceration, marked erythema, and edema with friable mucosa and hemorrhage. The patient was subsequently given mesalamine, and the symptoms resolved.

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“…Conditions mimicking ulcerative proctitis include sexually transmitted diseases ( Neisseria gonorrhoeae , Chlamydia trachomatis , herpes simplex virus, syphilis, giardiasis and amoebiasis) [18], psoriatic colitis [19], coexistent irritable bowel syndrome, chemical colitis [20] and Crohn's disease (CD) may present initially as ulcerative proctitis [21]. Refractory proctitis should be reassessed with a full medical history and examination, colonoscopy with biopsies and stool cultures.…”

Section: Proctitismentioning

confidence: 99%

Managing Intractable Proctitis and the Problematic Pouch

Kent

Keshav²

2014

Dig Dis

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Proctitis accounts for a significant proportion of cases of ulcerative colitis (UC), and some patients subsequently develop more extensive disease. However, most patients continue to have limited inflammation, although the changes in the distal colon and rectum can occasionally be severe, and symptoms of increased frequency, rectal bleeding and urgency can be as disabling as they are for patients with more extensive colitis. Furthermore, although symptoms are typically well controlled with standard medications, medically refractory proctitis poses particular problems. Patients generally are not systemically unwell, and there is no added fear of cancer. Therefore, the prospect of colectomy for such limited disease is resisted by patients, physicians and surgeons alike. Unusual therapies, often delivered locally by enema or suppository, have been tested in small case series without definitive outcomes. The pathogenesis of such limited, yet intractable inflammation remains unclear, and the differential diagnosis should be carefully reviewed to ensure that local disease, whether it is infectious, vascular, or a result of injury or degeneration, is not overlooked. Ileo-anal pouch formation is the surgery of choice for about 20% of patients with UC who undergo colectomy. In the majority of cases, this surgery results in an acceptable quality of life and freedom from a stoma. However, in a sizeable minority of cases, pouch dysfunction can cause intractable problems. The causes of pouch dysfunction are varied and must all be considered carefully, particularly in refractory cases. Pouchitis is a common issue and is usually transient and easily treated. However, refractory and chronic pouchitis can be challenging. Ischaemia, injury, infection and Crohn's disease can all cause refractory pouch dysfunction. In a minority of cases, there appears to be no apparent organic pathology, and the presumptive diagnosis is that of a functional pouch disorder. Although it is much rarer, neoplastic changes in the pouch must also be considered, and the risk managed appropriately. The management of both intractable proctitis and the problematic pouch is made more challenging by the wide differential diagnosis that must be considered and by the paucity of high-quality clinical trials to support any one therapy. Key strategies to overcoming these limitations include methodical and systematic investigation and review, and a willingness to tailor therapy to the individual patient. Clinical trials of new treatments should be supported, and data from the experience with small cohorts of patients should be meticulously collected, critically analysed and widely disseminated.

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Hydrogen peroxide exposure mimicking ulcerative proctitis

Cited by 9 publications

References 3 publications

Chemical colitis caused by hydrogen peroxide enema in a child: case report and literature review

Chemical colitis caused by hydrogen peroxide enema in a child: case report and literature review

Hydrogen Peroxide Enema-induced Proctitis in a Young Female: A Case Report

Managing Intractable Proctitis and the Problematic Pouch

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