Abstracts Submitted for the 69th Annual Scientific Meeting of the American College of Gastroenterology: October 29–November 3, 2004, Orlando, Florida: CLINICAL VIGNETTES
SELF-ADMINISTERED ALCOHOL (VODKA) ENEMA CAUSING SEVERE COLITIS
Alcohol has been used for many different purposes throughout history. There are rare reports of alcohol enemas being accidentally administered or being used as a part of sexual practice. We report a case of a 39-year-old male who self-administered an alcohol (vodka) enema and developed a severe colitis. A 39 year-old male with no significant past medical history was at a party when he self-administered an enema consisting of one part vodka to twelve parts water with a rubber bulb (total volume 5 ounces). He retained the enema for ten minutes. Within fifteen minutes he experienced abdominal pain and fecal urgency and had a series of bowel movements with bright red blood. Patient also experienced nausea and had four episodes of non-bloody emesis. Bowel movements continued for twelve hours, gradually decreasing in frequency. Over time his abdominal pain increased. On physical examination patient was moderately tender in both lower quadrants of his abdomen, left greater than right. He had a white blood cell count of 22500/mL and hemoglobin of 17.3 gm/dL. Abdominal series was negative. CT scan of the abdomen and pelvis with contrast revealed thickening of the sigmoid colon wall with no evidence of perforation. Flexible sigmoidoscopy done one day after admission revealed mucosa that was purple to black in color with no vascular pattern. The mucosa did not bleed with forcep biopsy. Pathology reports revealed severe colitis with mucosal infarction. The patient was treated conservatively and his hospital course included gradual resolution of bloody bowel movements and abdominal pain. The patient's white blood cell count decreased and he tolerated gradual advancement of his diet. Repeat flexible sigmoidoscopy done on the fifth hospital day revealed islands of regular mucosa amidst sloughed, ulcerated mucosa.
Alcohol can have a number of damaging effects on the GI mucosa. Laboratory studies on rodents have demonstrated significant damaging effects of alcohol on the jejunal and colonic mucosa. There are five case reports in humans of alcohol enemas causing severe colitis. This is the first reported case of alcohol-induced colitis in the United States.© The American College of Gastroenterology 2004. All Rights Reserved.