A Case of Acute Renal Failure due to Glycerin Enema for the Pretreatment of Esophagectomy

Abstract

Glycerin enema, which is widely used in daily medical service, rarely causes critical complications. A 56-year-old man, who was planned to undergo laparoscopic subtotal esophagectomy for lower thoracic esophageal cancer, had glycerin enema for pretreatment for the operation. Just after that, he felt heavy pain at his anus and had a small amount of bleeding. But the symptoms improved soon, so he was brought into the operating room. After general anesthesia was induced, a small amount of red urine was recognized by a catheter insertion for withdrawing urine. Cystoscope showed only a small amount of red urine from bilateral ureteral opening. A 5-mm shallow wound was also found at the anus on anoscopy. The operation was performed as planned because the laboratory test showed no abnormalities and there was no abnormal pattern in his vital signs. There was no urinary output during the operation, and anuria persisted after the operation. Acute renal failure was diagnosed because the serum creatinine got worse gradually. Therefore, continuous hemodiafiltration (CHDF) and haptoglobin substitution therapy were started. CHDF was done for ten days after the operation, and intermittent hemodiafiltration was also done 5 times by 20^th day after the surgery. The renal function improved gradually afterward, and he was discharged from the hospital on the 27^th postoperative day. His renal function became normal in two months from the surgery.

Acute renal failure as a serious complication of glycerin enema has not been fully understood because it occurs infrequently. We medical professions should acknowledge this possibility.