Ischemic colitis after enema administration: Incidence, timing, and clinical features

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Emergency Medicine

Background:

• Enema administration is common in emergency departments (ED).
• Concerns exist regarding enema agent safety due to reported cases of enema-related ischemic colitis (IC).
• Limited data exists on the incidence and characteristics of enema-related IC.

Purpose of the Study:

• To determine the incidence, timing, and risk factors of ischemic colitis (IC) in patients who received enemas.
• To specifically investigate glycerin enema-associated IC.

Main Methods:

• A consecutive data collection of adult patients receiving enemas in the ED from January 2010 to December 2018.
• Identification of patients diagnosed with IC post-enema.
• Comparison of 19 patients with glycerin enema-related IC to an age-matched control group.

Main Results:

• The incidence of IC was 0.23% among 8320 patients receiving glycerin enema; no IC occurred with other agents.
• The mean age of patients with glycerin enema-related IC was 70.2 years.
• IC typically occurred within 8 hours (79%) after glycerin enema, with constipation score and leukocytosis as independent risk factors.

Conclusions:

• Glycerin enema-related IC has an incidence of 0.23%, predominantly affecting the elderly early after administration.
• Constipation score and leukocytosis are significant risk factors for glycerin enema-related IC.
• These findings highlight the importance of risk assessment prior to glycerin enema use in the ED.