Chemical Iatrogenic Colitis
Definition
- Colitis secondary to chemical irritation
Alternate/Historical Names
- Glutaraldehyde-induced Colitis
Diagnostic Criteria
- Congestion and hemorrhage in mucosa
- Microthrombi
- Necrosis and sloughing of superficial mucosa
- History of recent endoscopy or introduction of foreign substance
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting : November 11, 2009
Differential Diagnosis
- E coli O157:H7 colitis may be histologically indistinguishable from chemical / iatrogenic colitis
- Clinical correlation is necessary
- Acute ischemic colitis may be histologically indistinguishable from chemical / iatrogenic colitis
- Clinical correlation is necessary
| Chemical / Iatrogenic Colitis |
Antibiotic-associated Pseudomembranous Colitis |
| Diffuse necrosis and sloughing of superficial mucosa |
Frequently patchy involvement of 2-10 crypts with normal surrounding crypts |
| Mucosal microthrombi and hemorrhage |
Not associated with microthrombi or hemorrhage |
| History of endoscopy or introduction of foreign substance |
History of antibiotic therapy |
Both may form a pseudomembrane
Clinical
- Most commonly due to inadequate rinsing of disinfectant from colonoscope
- Most common agent is glutaraldehyde
- Presents within 48 hours
- Fever, chills, abdominal pain
- Diarrhea, blood per rectum
- Self-limited to 4-5 days
- May be caused by self-administered naturopathic enemas or other foreign substance
- This may be difficult to elicit from patients
Bibliography
- Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N. Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
- Sheibani S, Gerson LB. Chemical colitis. J Clin Gastroenterol. 2008 Feb;42(2):115-21.
- Stein BL, Lamoureux E, Miller M, Vasilevsky CA, Julien L, Gordon PH. Glutaraldehyde-induced colitis. Can J Surg. 2001 Apr;44(2):113-6.
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