We report the case of a 37-year-old woman with severe acute proctocolitis and metabolic acidosis with loss of consciousness caused by a self-administered alcohol enema. The patient had a 10-year history of bipolar disorder. She was unconscious and in shock at arrival in the emergency room. After resuscitative procedures, a colonoscopy performed to determine the cause of the rectal bleeding showed severe inflammatory changes of the mucosa extending from the rectum to the descending colon, suggestive of ischemic colitis. She regained consciousness on the second day. On day 8, a repeat colonoscopy revealed healing of the rectum and sigmoid colon. We continued to treat the patient conservatively. On day 29, colonoscopy and radiography revealed inflammatory and stenotic changes of the descending and transverse colon. We performed a temporary colostomy on the right side of the transverse colon and the patient was discharged 23 days later. This is a rare case of severe and extensive proctocolitis caused by a self-administered alcohol enema.
2013 Japanese Society for Abdominal Emergency Medicine