Injury by hypertonic phosphate enema
Pietsch, J.B.; Shizgal, H.M.; Meakins, J.L.
Canadian Medical Association Journal 116(10): 1169-1170
1977
ISSN/ISBN: 0008-4409 PMID: 861870 Document Number: 119931
Three patients with extraperitoneal perforation of the anorectum secondary to administration of a hypertonic phosphate (Fleet) enema are described. With an animal model the effect of this injury of parenteral administration of emthylprednisolone was evaluated. In the 4 rabbits given an injection of saline the erythema lasted a few hours and disappeared by 24 h. In the 6 rabbits given an injection of hypertonic phosphate solution pronounced erythema and induration were evident by 24 h. In the 3 untreated rabbits the inflammation progressed to central necrosis and full-thickness tissue loss by 5-7 days. In the 3 rabbits treated with methylprednisolone the inflammation resolved over the next 5 days without any tissue loss. Successful treatment of irreparable tissue damage depend on early diagnosis and aggressive treatment with appropriate parenteral antibiotics and steroids.