Article, Gastroenterology

Gluteraldehyde-induced colitis: a rare cause of lower gastrointestinal bleeding

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Case Report

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American Journal of Emergency Medicine

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American Journal of Emergency Medicine 32 (2014) 685.e1-685.e2

Gluteraldehyde-induced colitis: a rare cause of Lower gastrointestinal bleeding

Abstract

Gluteraldehyde is an effective and widely used disinfectant. Despite the large volume of Endoscopic procedures carried out, gluteraldehyde- induced colitis is rare. It typically presents with acute onset of lower abdominal pain, fever, and bloody stool, within hours to up to 2 days of endoscopy. Even though a self-limiting condition, it is important for front line clinicians to be aware of this entity as procedure related complications is of major concern to patients and healthcare providers.

A 52-year-old lady with a past medical history of hypertension, dyslipidemia, and irritable bowel syndrome was admitted with a day history of abdominal pain, watery diarrhea, and per rectal bleed. She was very concerned since these symptoms had developed soon after a screening colonoscopy performed the previous day which was normal. She was well on discharge. On examination, she was afebrile and normotensive. Per Abdominal examination revealed a soft, mild tenderness on deep palpation in the lower left abdomen and active bowel sounds. Blood investigations were unremarkable with the hemoglobin and white cell count within normal limits. abdominal radiography revealed no perforation. As her symptoms persisted, a computed tomography scan was done and this showed thickened sigmoid colon with surrounding fat stranding of Inflammatory changes (Fig. A). She proceeded to a sigmoidoscopy which showed friable mucosa of colitis extending from distal rectum to the distal left colon (Fig. B). Histology revealed changes of Ischemic colitis. Stool evaluation

for bacteria was negative. The temporal trend was consistent with that of a proctosigmoiditis secondary to gluteraldehyde. He symptoms had completed resolved when she was seen two weeks after diagnosis.

Gluteraldehyde (2% solution) is an effective and widely used disinfectant, not just for endoscopic but also other instruments. Gluteraldehyde-induced colitis was first described in 1986 by Castelli et al [1]. Despite the large volume of endoscopic procedures carried out daily, gluteraldehyde-induced colitis is fortunately uncommon. The incidence ranged from 0.1% to 4.7% [2]. The mechanism of exposure to glateraldehyde is through inadequate rinsing of endoscopic channels or contamination of the rinsing water with gluteraldehyde [3]. Gluter- aldehyde-induced colitis typically presents with acute onset of lower abdominal pain, fever, and bloody stool, [4] usually soon and up to 48 hours after endoscopy. However, it is possible that milder cases may manifest with just self-limiting abdominal pain without bleeding laboratory investigations typically reveal leukocytosis and elevated C- reactive protein. Endoscopic features are similar to ischemic colitis [4]. Although typical, it is important to exclude bacterial infection or non- steroidal anti-inflammatory medications [5,6]. Diagnosis is through exclusion of other causes and the typical temporal trend [7,8].

Given the increasing number of endoscopic procedures done, it is important for clinicians to be aware and consider gluteraldehyde- induced colitis. Any symptoms soon after any procedures always raise concern of procedures related complications. Even though self- limiting, gluteraldehydE colitis is alarming to both patients and the clinicians or institutions.

A B

Fig. A, Axial computed tomography image showing thickened sigmoid colon (arrows). B, Endoscopic image showing colitis.

0735-6757/(C) 2014

685.e2 M.Z. Mohamad et al. / American Journal of Emergency Medicine 32 (2014) 685.e1685.e2

Muhamad Zulkhairi Mohamad, MBBS Endoscopy Unit, Department of Medicine RIPAS Hospital, Bandar Seri Begawan BA 1710

Brunei Darussalam

Kai Shing Koh, MBBS

Department of Accident and Emergency RIPAS Hospital, Bandar Seri Begawan BA 1710

Brunei Darussalam

Vui Heng Chong, FRCP Endoscopy Unit, Department of Medicine RIPAS Hospital, Bandar Seri Begawan BA 1710

Brunei Darussalam E-mail address: [email protected]

http://dx.doi.org/10.1016/j.ajem.2013.11.040

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