Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2020; 26(41): 6442-6454
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6442
Ischemic colitis after enema administration: Incidence, timing, and clinical features
Yura Ahn, Gil-Sun Hong, Ju Hee Lee, Choong Wook Lee, Seon-Ok Kim
Yura Ahn, Gil-Sun Hong, Ju Hee Lee, Choong Wook Lee, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine & Asan Medical Center, Seoul 05505, South Korea
Seon-Ok Kim, Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: All authors participated in performance of the research; Ahn Y collected clinical data, searched the literature, interpreted the data, and wrote the first draft of the manuscript; Hong GS designed the study, searched the literature, interpreted the data, and reviewed the manuscript; Lee JH and Choong WL contributed to the critical review of the manuscript; Kim SO performed statistical analyses; all authors approved the final version of the article.
Institutional review board statement: This retrospective study was conducted according to the principles of the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board Committee of the Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (No. 2018-0381).
Informed consent statement: The need for informed consent was waived by the Institutional Review Board Committee of the Asan Medical Center.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gil-Sun Hong, MD, PhD, Assistant Professor, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine & Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea. hgs2013@gmail.com
Received: August 3, 2020
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
Abstract
BACKGROUND

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.

AIM

To investigate the incidence, timing, and risk factors of IC in patients receiving enema.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Enema, Glycerin, Ischemic colitis, Incidence, Timing, Risk factors

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.