Chemical Colitis due to Peracetic Acid: a Case Report and Review of Literature

Abstract

Reprocessing of both endoscopic instruments and reusable disposals is mandatory to prevent infection transmission. However, toxic colitis due to endoscope contamination by different disinfectants following an imperfect washing has been reported. We present a case of peracetic acid-induced colitis and reviewed the literature. Overall, five cases of peracetic acid toxic colitis have been reported. All cases presented with “snow white sign” immediately appearing during endoscopy, two patients complaint of mild abdominal pain (one of whom had also fever and rectal bleeding), whilst the othesr remained totally asymptomatic. Only one patient received a 1-week metronidazole treatment. No immediate complications were observed, and no sequels occurred at clinical-endoscopic follow-up. The identified cause of disinfectant contamination was a defective either manual or automated rinsing of the colonoscope following the reprocessing procedure.( J Dig Endosc2011;2(1):15-17)

Keywords:

Toxic colitis - Chemical colitis - Peracetic acid - induced colitis - Reprocessing - Colonoscopy

• References

• 1 Spinzi G, Fasoli R, Centenaro R, Minoli G, SIED Lombardia Working Group. Reprocessing in digestive endoscopy units in Lombardy: results of a regional survey. Dig Liver Dis 2008;40:890–6.
• 2 Sheibani S, Gerson LB. Chemical colitis. J Clin Gastroenterol 2008;42:115-21.
• 3 Ahishali E, Uygur-Bayramic O, Dolapcioglu C, Dabak R, Mengi A, Iºik A, Ermiº E. Chemical colitis due to glutaraldehyde: case series and review of the literature. Dig Dis Sci 2008 Dec 23 [Epud ahead of print].
• 4 Cammarota G, Cesaro P, Cazzato A, Fedeli P, Riccioni ME, Sparano L, Vitale G et al. Hydrogen peroxide-related colitis (previously known as “pseudolipomatosi”): a series of cases occurring in an epidemic pattern. Endoscopy 2007;39: 916-9.
• 5 Ballantyne B, Jordan SL. Toxicological, medical and industrial hygiene aspects of glutaraldehyde with particular reference to its biocidal use in cold sterilization procedures. J Appl Toxicol 2001; 21:131–51.
• 6 Rideout K, Teschke K, Dimich-Ward H, Kennedy SM. Considering risks to healthcare workers from glutaraldehyde alternatives in high-level disinfection. J Hosp Infect 2005;59:4–11.
• 7 Pacenti M, Dugheri S, Boccalon P, Arcangeli G, Cupelli V. Evaluation of occupational exposure to high-level disinfectants in endoscopic services in an Italian hospital. Int J Immunopathol Pharmacol 2006;19 (Suppl. 4):73–7.
• 8 Morini S, Campo SMA, Zullo A, Guarini A, Ridola L, Hassan C. Chemical colitis induced by peracetic acid: further evidence. Endoscopy 2009;41:383 (letter).
• 9 Coton T, Bohand X, Guisset M, Carre D, Delpy R, Valette M, Debonne JM. Colite aigue induite par une solution de désinfenction des endoscopes à base d’acide peracétique (acute colitis induced by a peracetic acid solution used to disinfect endoscopes). Gastroenterol Clin Biol 2003;27:556-58.
• 10 Coriat R, Chaput U, Ismaili Z, Chaussade S. What induces colitis? Hydrogen peroxide or peracetic acid? Endoscopy 2007;40:231 (letter).
• 11 Lapeyre B. The “frost sign” and the “snow white sign”: intramucosal air injection or peroxide colitis? Endoscopy 2005;37:679 (letter).
• 12 Ryan CK, Potter GD. Disinfectant colitis. Rinse as well as you wash. J Clin Gastroenterol 1995;21:6-9.
• 13 Martiny H, Floss H. Residuals on medical devices following reprocessing. J Hosp Infect 2001;48 (Suppl A):S88-92. Review