title: Retrograde hydrostatic irrigation enema-induced perforation of the sigmoid colon in a chronic renal failure patient before colonoscopy.
abstract: We present a rare case of colon perforation caused by hydrostatic irrigation enema in a patient with chronic renal failure. A 76-year-old woman was admitted to our hospital because of an exacerbation of lumbar pain and increased difficulty in walking. She had a medical history of traumatic neck pain and chronic lower back pain, which had been treated with non-steroidal anti-inflammatory drugs (NSAIDs) for 8 years. On admission, the C-reactive protein level was 6.8 mg/dl, so we planned to do a colonoscopy to determine the cause of inflammation. The patient developed abdominal pain approximately 3.5 h after a pre-procedural enema was administered. An emergency operation was performed and a small perforation was found in the sigmoid colon. We conclude that the cause of the colon perforation was a combination of the use of a hydrostatic retrograde irrigation enema in a patient with chronic renal failure who had been treated with long-term NSAIDs.
authors.affiliation: Department of Nephrology, Showa University School of Medicine, Tokyo, Japan. h-mon@east.cts.ne.jp
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
authors.forename: M
authors.initials: M
authors.lastname: Iyoda
authors.forename: K
authors.initials: K
authors.lastname: Sato
authors.forename: K
authors.initials: K
authors.lastname: Kitazawa
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D012809:Colon, Sigmoid / Q000293:injuries*; D003113:Colonoscopy / Q000379:methods*; D004733:Enema / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000188:drug therapy; D007676:Kidney Failure, Chronic; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal