Phosphate Enema Causing Life-Threatening Rectal Perforation


Phosphate Enema Causing Life-Threatening Rectal Perforation


N. Bobb, V. Naraynsingh, S. Islam, Y. Singh, D. Harnanan, S. Cawich

Department of Clinical Surgical Sciences The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad, West Indies.


International-Journal-of-Case-Reports-2d code

We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.


Keywords: Enema, Rectal Perforation, Septic Shock


Free Full-text PDF


How to cite this article:

N. Bobb, V. Naraynsingh, S. Islam, Y. Singh, D. Harnanan, S. Cawich. Phosphate Enema Causing Life-Threatening Rectal Perforation. International Journal of Case Reports, 2020; 4:167. DOI: 10.28933/ijcr-2020-10-0805


References:

1. Doyle D. Per rectum: a history of enemata. J R Coll Physicians Edinb. 2005;35:367-370.
2. Sonnedicher G. Kremner’s and Urdang’s History of Pharmacy. JB Lippincott; 1951. Philadelphia: JB Lippincott; 1949.
3. Gijwilt-Hofstra M, van Heteren G, Tansey E. Biographies of Remedies: Dutch and American Healing Cultures. New York: Rodopi; 2002.
4. Mendoza J, Legido J, Rubio S, Gisbert J. Systematic review: the adverse effects of sodium phosphate enema. Alimentary Pharmacology & Therapeutics. 2007;26(1):9-20.
5. Bowers B. Evaluating the evidence for administering phosphate enemas. British Journal of Nursing. 2006;15(7):378-381.
6. Pietsch J, Shizgal H, Meakins J. Injury by hypertonic phosphate enema. CMA Journal. 1977;116:1169-1170.
7. Smith I, Carr N, Corrado O, Young A. Rectal Necrosis after a Phosphate Enema. Age and Ageing. 1987;16(5):328-330.
8. Blatt L. Injury of the Rectum by Tip of Disposable Enema. AMA Archives of Surgery. 1960;80(3):442.
9. Thiele J, Zander J. Enema-Induced Anorectal Injuries Trusting the warning signs is key to prevention and treatment Enema administration is not devoid of risk for the patient. In this article, the authors highlight two cases of anorectal inju-ry and discuss the steps critical to successful therapy, including recognition of damage. Postgraduate Medicine. 2002;111(1).
10. Sweeney J, Hewett P, Riddell P, Hoffmann D. Rectal gangrene: a complication of phosphate enema. Medical Journal of Australia. 1986;144(7):374-375.
11. Addison R, Ness W, Abulafi M, Swift I. How to administer enemas and suppositories. Nurs Times. 2000;96(6):3-4.
12. Wolfe W, Silver D. Rectal perforation with profuse bleeding following an enema. Arch Surg. 1966;92:715.
13. Bell A. Colonic Perforation with a Phosphate En-ema. Journal of the Royal Society of Medicine. 1990;83(1):54-55.
14. Samadian S. Rectal necrosis due to phosphate enema. Care of the Elderly. 1990;2(7):291.
15. Judd E, Pollock L. Diverticulitis of the colon. Ann Surg. 1924;80(3):425-438.
16. Shannon F, Moore E, Moore F, Mc Croskey B. Value of Distal Colon Washout in Civilian Rectal Trauma-Reducing Gut Bacterial Translocation. The Journal of Trauma: Injury, Infection, and Critical Care. 1988;28(7):989-994.
17. Burch J, Feliciano D, Mattox K. Colostomy and Drainage for Civilian Rectal Injuries. Annals of Surgery. 1989;209(5):600-611.
18. Bostick P, Johnson D, Heard J, Islas J, Sims E, Flemming A et al. Management of Extraperitoneal Rectal Injuries. Journal of The National Medical Association. 1991;85(6):460-463.
19. Atkin W. Single blind, randomised trial of efficacy and acceptability of oral Picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening Commentary: participants should have been told they were being randomised Commentary: opportunity for patient partnership was lost. BMJ. 2000;320(7248):1504-1509.