Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6442
Peer-review started: August 3, 2020
First decision: August 22, 2020
Revised: September 5, 2020
Accepted: October 1, 2020
Article in press: October 1, 2020
Published online: November 7, 2020
Enema administration is a common procedure in the emergency department (ED). However, several published case reports on enema-related ischemic colitis (IC) have raised the concerns regarding the safety of enema agents. Nevertheless, information on its true incidence and characteristics are still lacking.
To investigate the incidence, timing, and risk factors of IC in patients receiving enema.
We consecutively collected the data of all adult patients receiving various enema administrations in the ED from January 2010 to December 2018 and identified patients confirmed with IC following enema. Of 8320 patients receiving glycerin enema, 19 diagnosed of IC were compared with an age-matched control group without IC.
The incidence of IC was 0.23% among 8320 patients receiving glycerin enema; however, there was no occurrence of IC among those who used other enema agents. The mean age ± standard deviation (SD) of patients with glycerin enema-related IC was 70.2 ± 11.7. The mean time interval ± SD from glycerin enema administration to IC occurrence was 5.5 h ± 3.9 h (range 1-15 h). Of the 19 glycerin enema-related IC cases, 15 (79.0%) were diagnosed within 8 h. The independent risk factors for glycerin-related IC were the constipation score [Odds ratio (OR), 2.0; 95% confidence interval (CI): 1.1-3.5, P = 0.017] and leukocytosis (OR, 4.5; 95%CI: 1.4-14.7, P = 0.012).
The incidence of glycerin enema-related IC was 0.23% and occurred mostly in the elderly in the early period following enema administration. Glycerin enema-related IC was associated with the constipation score and leukocytosis.
Core Tip: Enema is a very safe and common procedure in the emergency department (ED). However, clinical information regarding ischemic colitis (IC) following enema is lacking. Our data shows that the incidence of IC was 0.23 % and occurred mostly in the elderly in the early period after administration of glycerin enema only. Despite the rarity of this disease, it can become relatively severe, resulting in the need for surgical resection. The independent predictive factors of glycerin enema-related IC were constipation scores and leukocytosis. Our data could provide useful information for the triage of patients necessitating observation after glycerin enema in the ED.