J Korean Surg Soc.  2011 Nov;81(5):350-354. 10.4174/jkss.2011.81.5.350.

Intractable rectal stricture caused by hot water enema

• Kye BH
• Kim HJ
• Lee KM
• Cho HM

• KMID: 2096690
• DOI: http://doi.org/10.4174/jkss.2011.81.5.350

Abstract

Rectal burns caused by hot water enema have been reported only occasionally and the majority of them were treated in a conservative manner. Although intractable rectal stricture caused by rectal burn is rare, it may be treated by endoscopic intervention or surgery. A 52-year-old woman who had used various methods of enema to treat her chronic constipation eventually undertook a hot water enema herself. After that, anal pain and constipation became aggravated prompting her to visit our clinic. Although various nonoperative treatments including endoscopic stenting were performed, her obstructive symptom did not improve and endoscopic findings had not changed. Hence, we performed a laparoscopic proctosigmoidectomy and transanal coloanal anastomosis with ileal diversion to treat the disease, and as a result, her obstructive symptom improved well. Corrective surgery such as resection of involved segment with anastomosis may be beneficial in relieving obstructive symptoms of an intractable rectal stricture caused by hot water enema.

Keyword

Hot water enema; Rectal burn; Rectal stricture; Constipation

MeSH Terms

Burns
Constipation
Constriction, Pathologic
Enema
Female
Humans
Middle Aged
Stents
Water
Water

Figure

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  Fig. 1 Second-degree burn scar found on both of her buttocks.

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  Fig. 2 Initial flexible sigmoidoscope revealed active proctitis. Fig. 2A shows most severe stenosed area at 12 cm from the verge, and Fig. 2B shows cicatrical change and nodular appearance of rectal mucosa.

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  Fig. 3 Barium enema shows diffuse luminal narrowing with mucosal nodularity in rectum and distal sigmoid colon. Arrow indicates prominent segmental luminal narrowing in distal sigmoid colon. Proximal bowel loops to this lesion are distended.

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  Fig. 4 At two months after endoscopic stenting, edema and erythema of rectal mucosa was persistent. Fig. 4A shows stenting site and Fig. 4B shows erythematous rectal mucosa.

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  Fig. 5 At three weeks after removal of stent, inflammation with severe edema and erythema of rectal mucosa, ulceration, easy-touch bleeding and aggravated luminal narrowing continued.

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  Fig. 6 (A) Surgical specimen shows severe inflammatory change from entire rectum to distal sigmoid colon. (B) Histologic examination reveals diffuse transmural chronic inflammation with fibrosis (×10 HPF).

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