Glutaraldehyde-induced colitis (original) (raw)
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Chemical Colitis Due to Glutaraldehyde: Case Series and Review of the Literature
Digestive Diseases and Sciences, 2009
Chemical colitis can occur as a result of accidental contamination of endoscopes or by intentional/ accidental administration of enemas containing various chemicals. We present three cases of glutaraldehyde induced colitis and review the cases in the literature. Glutaraldehydeinduced colitis presents clinically with severe abdominal pain, bloody and mucoid diarrhea, rectal bleeding, and tenesmus 48-72 h after colonoscopy. Endoscopic findings are nonspecific and mimic ischemic colitis, inflammatory bowel disease, and infectious colitis. The timing of symptoms and the knowledge that glutaraldehyde is a chemical irritant to colonic mucosa is important for the diagnosis. The treatment is mainly supportive but sometimes necessitates mesalamine, prednisolone, or metronidazole and the resolution is rapid. In endoscopy units, strict adherence to published disinfection protocols is very important and the cleaning, rinsing and drying protocols also deserve the same attention.
Ischemic Colitis Caused by Bowel Preparation for Colonoscopy
Gastroenterology Research, 2021
Background: Ischemic colitis is an adverse event which may occur during bowel preparation for colonoscopy. This study aims to clarify both the incidence and the risk factors of this complication. Methods: This was a single-center, retrospective, observational study. All outpatients who were prescribed standardized preparation drugs for colonoscopy at the Kyoto Second Red Cross Hospital between November 2011 and March 2020 were included in the study. A split bowel preparation was carried out as follows; magnesium citrate with or without sodium picosulfate hydrate was/were used as a preparation drug on the day before the colonoscopy, and polyethylene glycol electrolyte solution or sodium phosphate was used on the morning of the endoscopic procedure. Patients were extracted from the electronic medical records and matched with the endoscopy database by examination date and hospital identification number. Following the endoscopic findings, both the incidence and risk factors for ischemic colitis arising after bowel preparation were examined. Results: Among the 14,924 patients analyzed, ischemic colitis was observed in 14 patients (0.09%). Multivariate analysis revealed that old age (≥ 75 years old) and strong preparation (magnesium citrate with sodium picosulfate and polyethylene glycol electrolyte solution) for constipated patients were independent risk factors for ischemic colitis (odds ratio: 3.64 (95% confidence interval (CI): 1.36-9.77) and 4.27 (95% CI: 1.45-12.53), respectively). Conclusions: The age 75 years and above and strong preparation for patients with constipation were independent risk factors for ischemic colitis prior to colonoscopy. Careful attention should be paid to bowel preparation before colonoscopy for patients aged ≥ 75 years and for those with constipation.
The role of an endoscopy in inflammatory bowel disease
Clinical Update, 2008
When a patient presents with bloody diarrhea, the diagnosis is colitis until proven otherwise. It is possible that the patient has some other diarrheal disorders or hemorrhoidal bleeding, however, colitis needs to be considered. A primary care physician should be determining whether the symptoms have been acute (<4 weeks) or chronic (>4 weeks) or recurrent, whether the patient has risk factors for different colitides (antibiotic use, past pelvic radiotherapy, a family history of inflammatory bowel disease [IBD]), and if there are relevant physical findings (such as an abnormal abdominal examination or blood on the rectal examining glove). After coordinating routine blood work (most importantly, a complete blood count) and stool tests (bacterial culture, Clostridium difficile toxin, and ova and parasite testing, if appropriate), the next step is a referral for a colonoscopy. In a patient with a positive stool test for a Clostridium difficile toxin or other bacterial pathogens, treatment can be initiated and an endoscopy can be deferred. An endoscopy should be pursued if the patient has recurrent or persistent symptoms after treatment. Should the patient have a flexible sigmoidoscopy or a full colonoscopy? If he or she is not too ill, then it may be reasonable to properly prepare the patient for a full colonoscopy, which would facilitate assessment of the entire colon (hence, if the lower left side of the colon is normal, then the rest of the bowel can still be assessed) and the terminal ileum. In all cases of colitis, the ileum should be intubated to complete the assessment. If the patient is quite ill, then a flexible sigmoidoscopy may be sufficient, particularly if the left side of the colon is abnormal. At that point, regardless of the disease extent, the endoscopist can take biopsy specimens to help sort through the diagnosis and also suction liquid stool out of the colon to be sent to the microbiology laboratory. The initial assessment at a colonoscopy is a retroflexed view of the anorectum to determine whether internal hemorrhoids exist and also whether there might be inflammatory changes in the lower 2 to 3 cm of the rectum. Ulcerative proctitis or radiation proctitis can affect only the very distal rectum, and this can be missed if a retroflexed view is not undertaken. The endoscopist should then describe the abnormalities: whether there is granularity, loss of vascular pattern, friability, exudate, or ulceration, and whether the abnormalities are confluent or patchy or whether they discretely skip in distribution. However, whatever findings of inflammation the endoscopist identifies, it is important to be aware that these findings are all nonspecific. Often, Crohn's disease of the colon (in the absence of www.asge.org
Cureus, 2022
Ischemic colitis is one of the most common ischemic pathologies of the gastrointestinal system and can be divided into non-gangrenous and gangrenous forms. The pathophysiology involves restricted blood supply to the colonic mucosa. Several risk factors have been implicated in the development of ischemic colitis. Lactulose, one of the mainstay therapies for the treatment of hepatic encephalopathy in patients with cirrhosis, has been rarely reported as a cause of ischemic colitis. To the best of our knowledge, there has been only one case report associating lactulose use with the development of ischemic colitis. The exact pathophysiology is unknown but might be associated with the fermentation of lactulose by intestinal bacteria, causing gaseous distention and increasing the intraluminal pressure. We present the case of a 77year-old African American male, a known case of non-alcoholic liver cirrhosis with portal hypertension and esophageal varices, brought in by his family to the emergency department for altered mental status, nonbilious vomiting, abdominal distension, and pain for one day. On physical examination, the patient had upper extremity asterixis and was alert but disoriented to place and person. Diagnostic paracentesis was performed, which revealed leukocytosis, predominantly neutrophils. The patient was admitted for spontaneous bacterial peritonitis and hepatic encephalopathy with decompensated liver cirrhosis. The patient was started lactulose with a goal of three to four bowel movements per day. Despite adequate treatment, the patient continued to develop worsening mental function and abdominal distension. This was later followed by a bloody bowel movement. Laboratory assessment showed an elevated white blood cell count, worsening kidney function, and high anion gap metabolic acidosis. CT scan revealed dilated loops of bowel with air and fluid along with submucosal wall edema, findings suggestive of ischemic colitis. Given the poor prognosis and the patient's condition, colonoscopy was deferred. Lactulose was discontinued, as it was thought to be a contributing cause of the patient's ischemic colitis. His condition continued to deteriorate, and he passed away on Day 18 of admission.
Ischemic colitis: A forgotten entity. Results of a retrospective study in 118 patients
Journal of Digestive Diseases, 2014
The aim of our study was to document our 6-year experiences in identifing the clinical characteristics, laboratory findings, risk factors and the outcomes of patients with ischemic colitis (IC) in a community hospital setting. METHODS: The medical records of patients who were diagnosed with IC from 2007 to 2013 in two community hospitals were retrospectively reviewed. Their clinical characteristics, laboratory results, radiological, endoscopic and histological evidence, anatomic location of the lesion, comorbidities, concomitant use of drugs, and so on, were collected. RESULTS: A total of 118 patients with IC was identified, most were elderly individuals with a female predominance. The most common symptoms were abdominal pain, rectal bleeding and diarrhea. Hypertension, hyperlipidemia, coronary artery disease and diabetes mellitus were the most common comorbidities. Erythema, edema and erosions/ ulcerations were the most common endoscopic findings. Left colon was the most affected location of lesion (84.8%), and there was one case of pancolitis. The descending colon was the most common affected segment, while rectum was the least affected segment. Severe IC occurred in 12.7% of the patients. Death within 30 days from the diagnosis of the disease occurred in 4.2%. CONCLUSIONS: IC is majorly occurred in elderly with a female predominance. Cardiovascular disease and its assoicated risk factors are the most common comorbidities. Left colon is the most affected location of the disease and the overall mortality rate was 4.2%. Physicians should make every effort to identify these patients, especially those with high risks.
Implications of abnormal pathology in fulminating colitis on the outcome of surgery
Pathophysiology : the official journal of the International Society for Pathophysiology / ISP, 2011
The severe relapse of the diseases in patients with Crohn's disease or ulcerative colitis is associated with high morbidity and mortality. Early prediction for the failure of aggressive medical treatment and consequently, early surgical interference in cases with severe colitis and severe Crohn's colitis are supposed to be effective means for reducing these high rates. Patients who presented at the Accident & Emergency Department with severe colitis and severe Crohn's colitis and on whom emergency colectomy was operated were identified and they formed the basis of this study. Patients (n=34) with acute fulminating colitis and their condition required emergency colectomy were seen over a period of 5 years. A strategy of early detection of cases of toxic dilatation and/or perforation proved efficient in reducing morbidity and mortality in cases of severe colitis. The mortality in the presented series was zero and the morbidity occurred mainly in such cases that presented w...