A case of headache and hemolysis caused by a glycerin enema

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 73; no. 8; pp. 2152 - 2155
• Main Authors: MURAYAMA, Hiroyuki, KIMURA, Shinichi, TAKASAKA, Yoshihiro, HIRATA, Hirohisa, WATANABE, Kazunao
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2012
• Subjects: glycerin enema; hemolysis; renal failure
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.73.2152

We report a case of headache and hemoglobinuria developing after a glycerin enema. A 73-year-old man complained of constipation. He was admitted in order to stabilize his bowel movements. He was initially given a 120-ml 50% glycerin enema to deal with his constipation. However, 30 minutes later, he complained of a headache and lower abdominal pain. He had perianal swelling and some anal bleeding. Rectal examination showed mucosal injury and submucosal swelling, but no hemorrhoids. The brain computed tomography (CT) was normal. However, abdominal CT showed a low-density area around the rectum that spread to the aortic bifurcation. The patient's urine became brown in color. Blood tests done 2 hours after the glycerin enema showed serum LDH and creatinine level increases. Based on these findings, hemolysis and renal dysfunction caused by the entrance of glycerin into the blood stream was diagnosed. A percutaneous drain was positioned on the posterior side of the rectum, and antibiotics were given. To prevent the renal dysfunction from progressing, haptoglobin and furosemide were given intravenously. These therapies were effective. The patient did not need renal dialysis ; he recovered fully. Glycerin enema is commonly used to treat constipation and to prepare patients for gastrointestinal surgery, but there can be serious complications. Obviously, a glycerin enema must be given with due attention.