Amulya Reddy, DO1, Mary Barbara, MD1, Frank Lopez, DO2, Raxit Patel, MD3, Mimi Van, DO3 1Midwestern University, Mesa, AZ; 2Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ; 3Reddy GI Associates, Mesa, AZ
Introduction: Colonic hydrotherapy, also known as colonic irrigation, is a procedure that is offered in facilities such as spas and wellness centers. Herein we present an unusual case of a patient who developed peritonitis following colonic hydrotherapy.
Case Description/Methods: A 39-year-old woman without significant past medical history presented with four-day history of abdominal pain after undergoing colonic hydrotherapy four days prior. Pain was initially in the epigastric region but was now diffuse and associated with nausea. Admission labs were largely unremarkable. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed mild diffuse edema and small amount of scattered free fluid within the mesenteric fat of the abdomen and pelvis with concern for peritonitis (Figure 1). She had a follow up CT abdomen and pelvis with rectal contrast and no extravasation of contrast was seen, but some mucosal thickening in mid-sigmoid colon was noted. The patient was treated with a seven-day course of Augmentin and discharged home. She subsequently underwent an outpatient colonoscopy which revealed undetermined colitis throughout entire colon. Sigmoid colon biopsies were unremarkable.
Discussion: Colonic hydrotherapy involves the administration of a large volume of fluid, up to 60 liters, per rectum and the expulsion of waste through another tube[1]. While there is currently no scientific evidence to promote its use, people undergo colonic hydrotherapy due to the promise that it promotes gastrointestinal health as well as alleviates a myriad of symptoms. Adverse effects of colon cleansing range from mild GI symptoms to liver toxicity [1]. Reports of infections associated with colonic irrigation are limited and include an amebiasis outbreak in Colorado due to contaminated equipment, rectal perforation, and a case of E. coli septic shock [2]. It is thought that increased intraluminal pressure during colonic hydrotherapy results in bacterial translocation into the peritoneal cavity [2]. It is important to discuss the adverse effects of colonic irrigation with patients and to consider peritonitis as a differential when someone presents with abdominal pain post-colonic hydrotherapy.
Figure: Figure 1: CT of the abdomen and pelvis with intravenous contrast revealed mild diffuse edema and small amount of scattered free fluid within the mesenteric fat of the abdomen and pelvis with concern for peritonitis.
Disclosures: Amulya Reddy indicated no relevant financial relationships. Mary Barbara indicated no relevant financial relationships. Frank Lopez indicated no relevant financial relationships. Raxit Patel indicated no relevant financial relationships. Mimi Van indicated no relevant financial relationships.
Amulya Reddy, DO1, Mary Barbara, MD1, Frank Lopez, DO2, Raxit Patel, MD3, Mimi Van, DO3. P1210 - A Rare Presentation of Peritonitis After Colonic Hydrotherapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
