title: Solitary rectal ulcer induced by excessive use of analgesic suppositories containing paracetamol, caffeine, and codeine.
abstract: We report the case of a 53-yr-old woman who developed an ulcer of the distal rectum with mild stenosis after prolonged use of suppositories containing paracetamol, caffeine, and codeine. After undergoing extensive diagnostic tests with exclusion of other possible causes, she admitted to the abuse of the suppositories. She was treated with frequent endoscopic balloon dilations to prevent progression of the rectal stenosis. Because of severe pain on defecation, she needed a protective colostomy which could be closed after the healing of the ulcer 7 months later. There was no significant residual stenosis. This case is compared to cases described in the past 30 years.
authors.affiliation: Department of Medicine, Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany.
authors.forename: M G
authors.initials: MG
authors.lastname: Naumann
authors.forename: R
authors.initials: R
authors.lastname: Hintze
authors.forename: M
authors.initials: M
authors.lastname: Karaus
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002110:Caffeine / Q000009:adverse effects*; D003061:Codeine / Q000009:adverse effects*; D004338:Drug Combinations; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012002:Rectal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D013488:Suppositories / Q000009:adverse effects*; D014456:Ulcer / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D004338:Drug Combinations; D013488:Suppositories; D000082:Acetaminophen; D002110:Caffeine; D003061:Codeine