Chemical colitis induced by peracetic acid: further evidence

Chemical colitis induced by peroxide agents used to sterilize endoscopes is characterized by ”snow white signs“ or ”frost signs“ appearing during colonoscopy [1] [2] [3] [4] [5] [6]. However, it remains unclear whether the colitis was really induced by the peracetic acid or, more likely, by the hydrogen peroxide [5] [6]. Peracetic acid is known to cause chemical colitis by releasing free oxygen and hydrogen radicals when in contact with the mucosa [3] [7]. Only twelve cases of chemical colitis due to peracetic acid residuals on colonoscopes have been reported [5] [7]. Recently, we observed two cases of chemical colitis in a 51-year-old woman and a 49-year-old man using a standard colonoscope (Olympus CF-Q145), which had been disinfected by peracetic acid in an automated system.

To remove residual fecal matter from the cecal region (patient 1) and from the left flexure of the colon (patient 2), a wash of 60 mL of water applied via a sterilized syringe through an adjunctive channel applied to the colonoscope was required ([Fig. 1]). Immediately, several ”snow white signs“ appeared on the mucosa with whitish plaque lesions ranging in size from a few millimeters to centimeters in the area of mucosa washed with the water ([Fig. 2]). Histologic evaluation showed a feature of ”pseudolipomatosis.” A technical check of the reprocessing machine failed to find a malfunction. Both the patients remained asymptomatic. An endoscopic check 6 months (patient 1) and 2 months later (patient 2) did not show any residual lesion.

Fig. 1 Adjunctive channel used to wash (arrows).

Fig. 2 Endoscopic feature of peracetic-induced colitis.

As both cases occurred immediately following the addition of water via the adjunctive channel to wash the mucosa, we suspected either an inadequately washed channel during the reprocessing procedure or an incorrect connection of this channel with the automated machine, so that peracetic acid could enter this channel. These two further cases clearly confirm that chemical colitis can occur with peracetic acid [5] [6]. Unlike the previously reported cases, our patients were totally asymptomatic, and the endoscopic lesions were self-limiting. Finally, we have identified a possible cause of disinfectant contamination – i. e. the adjunctive channel for washing – that should be kept in mind during the reprocessing.

Competing interests: None

References

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