title: Caustic burns of rectum and colon in emergencies.
abstract: BACKGROUND
  Because of their rarity, chemical burns of rectum and colon have been poorly studied. This clinical report studies the epidemiologic, diagnostic, and therapeutic features of rectal and colonic burns after enema with caustics.
  
  
  METHODS
  This is a retrospective clinical report of a personal series of 21 patients admitted in our hospital from January 1990 to January 2000 for an acute chemical colitis after enema.
  
  
  RESULTS
  Inpatient prevalence: 0.04%. Mean age: 29.7 +/- 12 years (range 17 to 19). Sex ratio: 16 female and 5 male. Circumstances: suicide (n = 14), abortion (n = 3), murder (n = 3), mistake (n = 1). Responsible caustic: sulphuric acid (n = 12), chlorhydric acid (n = 5), potash (n = 2), unknown acid (n = 1), plant decoction (n = 1). Injected quantity: 50 to 250 mL. Ten patients suffered light damage and had an early favorable course under medical treatment, 8 of them had a secondary rectal-sigmoid stenosis. Eleven patients presented with severe necrotic damage, of difficult and often delayed diagnosis based on an enduring symptomatology without clear peritoneal syndrome. Upon surgery, necrotic damage spread on rectum and sigmoid colon (n = 2), up to the transverse colon (n = 4), to the right colonic angle (n = 3), to the right colon (n = 2); once a 10 cm long necrosis of the ileum was associated (n = 1); only 1 patient had a colonic perforation. Performed surgery: 11 resections of necrotic colon and proximal colostomy (Hartman operation). Mortality: 6 patients. Morbidity: 3 of 5 patients.
  
  
  CONCLUSIONS
  Chemical burns of rectum and colon produced by strong acid or basic products are necrotizing lesions whose gravity is often hidden by the absence of peritoneal inflammation signs, thus mortality is high. Only early surgery is likely to improve the poor prognosis of severe chemical damage of the rectum and colon.
authors.affiliation: Department of Digestive Surgery 0B, University Hospital of Fort-de-France, BP 632- 97261 Fort-de-France Cedex, Martinique, France. diarrab@yahoo.fr
authors.forename: Brahima
authors.initials: B
authors.lastname: Diarra
authors.forename: Jean
authors.initials: J
authors.lastname: Roudie
authors.forename: Francis
authors.initials: F
authors.lastname: Ehua Somian
authors.forename: Adama
authors.initials: A
authors.lastname: Coulibaly
mesh_terms: D000024:Abortion, Illegal; D000328:Adult; D002057:Burns, Chemical / Q000209:etiology / Q000601:surgery; D002424:Caustics / Q000008:administration & dosage*; D002648:Child; D003092:Colitis / Q000139:chemically induced; D003106:Colon / Q000293:injuries*; D007560:Cote d'Ivoire; D004630:Emergencies; D004733:Enema; D005260:Female; D006708:Homicide; D006801:Humans; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D013406:Suicide, Attempted
chemical_list: D002424:Caustics