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Two Cases of Colonic Injury Secondary to Coffee or Dilute Hydrogen Peroxide Enemas: Colonoscopic and Radiologic Findings


Orosey, Molly DO, MS; RamiReddy, Srinivas MBBS; Mogrovejo, Estela MD; Cappell, Mitchell S. MD, PhD, FACG

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S836-S837
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Enemas consisting of coffee and hydrogen peroxide (H2O2) are unconventionally used for detoxification and such use can lead to colonic injury manifesting as colonic colitis, colonic stricture, rectal perforation, and sepsis.

Colonoscopy demonstrating patchy areas of congested, erythematous, granular, and inflamed mucosa.
Colonoscopy demonstrating patchy areas of ulcerated mucosa in the distal colon.
CT Abdomen/Pelvis showing evidence of intramural gas throughout the subserosal bowel walls. Findings are most pronounced at the ascending and transverse colon.

Case 1: A 24-year-old woman who chronically self-administered coffee enemas for “detoxifying” her liver presented with lower abdominal pain, rectal pain, and several episodes of hematochezia for one day. She presented several hours after self-administration of the enema. No use of non-steroidal anti-inflammatory medications or oral contraceptives was noted. Physical examination revealed normal vital signs and lower abdomen tenderness without rebound tenderness. Laboratory tests revealed normal hemoglobin and leukocyte count. Colonoscopy showed patchy areas of moderately erythematous, edematous, granular, inflamed and ulcerated mucosa in the rectum and distal sigmoid colon. Pathologic examination of colonoscopy biopsies demonstrated erosions and focal ulcer exudate without crypt distortion, suggestive of ischemic injury. Patient was conservatively treated and discharged home after three days without residual symptoms.

Case 2: A 30-year-old man who chronically self-administered dilute H2O2 enemas to “treat” his “mental cloudiness” presented with abdominal pain, diarrhea, and rectal bleeding after self-administration of the enema. Physical examination revealed normal vital signs and mild tenderness to palpation in the left lower quadrant. Laboratory tests showed hemoglobin 15.4 gm/dL, leukocyte count of 13,600 ccm/mm3, and lactic acid 1.0 mmol/L. Computed tomography (CT) abdomen with contrast demonstrated intramural gas in the subserosal bowel wall throughout the colon, most pronounced in the ascending and transverse colon, compatible with pneumatosis coli. He was admitted for bowel rest, intravenous fluids and antibiotics. He was managed conservatively with symptomatic improvement in symptoms and was discharged with outpatient follow-up. Coffee enemas are popularly believed to cause dilatation of the bile ducts and excretion of toxic products by the liver. Diluted H2O2 enemas are popularly believed to cleanse the colon from toxins. There is no evidence of their therapeutic efficacy, but people still use these enemas following recommendations by alternative medicine practitioners or from unscientific websites. Patients should be well educated about the unproven benefit and dangers of such enemas.

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