Acute rectocolitis following endoscopy in health check-up patients--glutaraldehyde colitis or ischemic colitis?
OBJECTIVE
Acute rectocolitis is a rare complication that follows endoscopy. It could be caused by glutaraldehyde or ischemic injury. The clinical, endoscopic, radiological, and pathological features of glutaraldehyde-induced colitis may mimic those of ischemic colitis. We reported our experiences regarding this problem.


METHODS
The medical records of patients with acute rectocolitis following endoscopy treated at Kaohsiung Veterans General Hospital since 2001 were reviewed. The indication of endoscopy was health check-up for all patients. Published English-language studies regarding acute rectocolitis following endoscopy were also reviewed.


RESULTS
An outbreak of six patients occurred in April 2002 and one cirrhotic patient was admitted in July 2008. All patients developed a self-limited syndrome of abdominal pain and bloody diarrhea within 48 h of uncomplicated endoscopy. One severely ill patient required hospitalization to receive intravenous fluid and antibiotics. After the investigation in April 2002, glutaraldehyde-induced colitis was diagnosed due to a defect in the endoscope-cleansing procedure. There were no any deficiencies in the cleansing procedure in July 2008. Considering the patient's concomitant disease, we postulated that ischemic colitis with cirrhosis-related intestinal inflammation and endotoxemia was the possible diagnosis in this sporadic case.


CONCLUSIONS
Endoscopists should be aware of this iatrogenic complication in patients presenting with acute rectocolitis, especially in those who have undergone recent endoscopic examination. An outbreak of acute rectocolitis following endoscopy should be considered glutaraldehyde-induced and should lead to an investigation of cleansing and equipment-disinfection procedures. In the absence of strong evidence of an outbreak, an infectious disease, or contamination of glutaraldehyde, a sporadic case should be considered ischemic colitis especially in patients with relevant concomitant diseases or predisposing factors.
Hsu
Chao-Wen
CW
Division of Colorectal surgery, Department of Surgery, Kaohsiung Veteran General Hospital, Kaohsiung City, Taiwan, 81346, Republic of China.
Lin
Chieh-Hsin
CH
Wang
Jui-Ho
JH
Wang
Hsin-Tai
HT
Ou
Wen-Chieh
WC
King
Tai-Ming
TM
D000208:Acute Disease; D000368:Aged; D017091:Colitis, Ischemic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003287:Contrast Media; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D005976:Glutaral / Q000009:adverse effects*; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000009:adverse effects*; D011350:Proctocolitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D005976:Glutaral