Ritual-enema-induced colitis

Summary and Conclusions

Enemas are routinely used in South Africa for various reasons including for ritual purposes; as an aperient, aphrodisiac or emetic; and for the treatment of impotence, febrile symptoms, abdominal pains, dysmenorrhea and dysentery. Substances used include herbal medicines, Dettol, vinegar, caustics, soap, potassium dichromate, copper sulfate, potassium permanganate, and brown sugar. Eleven patients in whom colitis developed following enema administration are described. Peritonitis and rectal bleeding are the clinical hallmarks. Features demonstrated by roentgenogram vary from ostensibly normal to fistula and stricture formation. In mild cases, there are occasionally neutrophils in the lamina propria; in severe cases, complete necrosis of the bowel wall is observed. Conservative therapy is advocated for the mild cases. The type of operative treatment performed depends on the complication observed.