Sailaja Pisipati, MD, FRCS1, Wut Yi Phoo, MD1, Ting Hui Hsieh, MD2, Tom Fang, MD2, Kirk Bronander, MD1
1University of Nevada Reno School of Medicine, Reno, NV; 2Renown Regional Medical Center, Reno, NV
Introduction: Chemical colitis can occur as a result of accidental or intentional exposure to various chemicals including alcohol. Ethanol enemas, practiced either to avoid hangovers and upper gastrointestinal (GI) symptoms or as klismaphilia appears to be dangerous practice. We report a rare case of alcohol-induced proctocolitis in association with sexual fetish.
Case Description/Methods: 38-year-old female with depression, bipolar disorder, polysubstance abuse, presented with lower abdominal and rectal pain, hematochezia, and tenesmus upon waking up. On questioning, she said that night prior to presentation, she was intoxicated (vodka, methamphetamine), participated in consensual intercourse when her partner “spit” vodka into rectum. She was mildly tachycardic. Examination revealed a distressed, tearful, dehydrated female with lower abdominal tenderness. Labs revealed leukocytosis, metabolic acidosis and hyperchloremia. Urine toxicology was positive for amphetamines, benzodiazepines, opiates, cannabinoids. Blood alcohol level was zero. CT demonstrated diffuse wall thickening of rectum and distal sigmoid colon. She was admitted for hydration, analgesia, systemic antibiotics and was placed nil per oral. Colonoscopy revealed longitudinal ulcers predominantly in the rectum with erythema and erosions extending up to 20cms above the anus. Biopsies showed mild nonspecific inflammation. Hydrocortisone enemas, stool softeners and oral diet were commenced. Follow-up sigmoidoscopy in six weeks was advised, patient did not attend.
Discussion: Intentional administration of alcohol enemas has been implicated in sexual practices, suicidal attempts, bowel cleansing, hemorrhoidal pain relief. Symptoms of abdominal pain, diarrhea, hematochezia, tenesmus develop within 24hours. Endoscopic evaluation reveals edema, friable, hemorrhagic or necrotic mucosa with ulcerations. Histologic features include mild erythema, extensive mucosal sloughing, necrosis. Diagnosis can be challenging if pertinent history is not obtained, given the non-specific nature of clinical, endoscopic and histological findings. Ischemic colitis, perforation and peritonitis, respiratory depression and CO2 narcosis causing noncardiogenic pulmonary edema and death are potential complications. Severity depends on the amount and speed of administration. GI symptoms usually resolve within 7-10 days. Careful history taking, particularly sexual practices, is crucial when evaluating young healthy individuals with lower abdominal pain and colitis of unclear etiology.
Citation: Sailaja Pisipati, MD, FRCS; Wut Yi Phoo, MD; Ting Hui Hsieh, MD; Tom Fang, MD; Kirk Bronander, MD. P0452 - NEVER ASSUME, ALWAYS ASK: BEYOND INFECTIOUS AND INFLAMMATORY PROCTOCOLITIS. Program No. P0452. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.