REVIEW Chemical Colitis Due to Glutaraldehyde: Case Series and Review of the Literature Emel Ahishali Æ Oya Uygur-Bayramic ¸li Æ Can Dolapc ¸iog ˘lu Æ Res ¸at Dabak Æ Alperen Mengi Æ Aygu ¨n Is ¸ik Æ Elvan Ermis ¸ Received: 7 August 2008 / Accepted: 12 November 2008 / Published online: 23 December 2008 Ó Springer Science+Business Media, LLC 2008 Abstract Chemical colitis can occur as a result of acci- dental contamination of endoscopes or by intentional/ accidental administration of enemas containing various chemicals. We present three cases of glutaraldehyde induced colitis and review the cases in the literature. Glutaraldehyde- induced colitis presents clinically with severe abdominal pain, bloody and mucoid diarrhea, rectal bleeding, and tenesmus 48–72 h after colonoscopy. Endoscopic findings are nonspecific and mimic ischemic colitis, inflammatory bowel disease, and infectious colitis. The timing of symp- toms and the knowledge that glutaraldehyde is a chemical irritant to colonic mucosa is important for the diagnosis. The treatment is mainly supportive but sometimes necessitates mesalamine, prednisolone, or metronidazole and the reso- lution is rapid. In endoscopy units, strict adherence to published disinfection protocols is very important and the cleaning, rinsing and drying protocols also deserve the same attention. Keywords Chemical colitis Á Glutaraldehyde Á Endoscopy Glutaraldehyde causes acute, self-limiting colitis after direct contact with the colonic mucosa. In endoscopic units, glu- taraldehyde is a widely used disinfectant. About 2% solution of glutaraldehyde has a broad spectrum of action against acid- and alcohol-resistant bacilli, hydrophilic viruses, and spores [1]. We report three cases of chemical colitis due to glutaraldehyde and review the cases in the literature. Case Series Case 1 A 59-year-old female patient who was asymptomatic was under colonoscopy surveillance because of colon cancer in her mother since 2 years. There was no history of any other disease or drug usage. She had multiple small polyps in the cecum and descending colon in her previous colonoscopy 2 years previous, which had been excised at the time and she was referred for control colonoscopy. After regular bowel cleansing with phosphosoda, colonoscopy was per- formed uneventfully and without any complaints, and at endoscopy colonic mucosa was completely normal without any polyps. The patient returned to the endoscopy unit 2 days later with symptoms of rectal bleeding and abdominal pain. She said that 6–7 h after the colonoscopy, the crampy abdominal pain started but it was not very severe, and 36 h later she had rectal bleeding with increasing pain. The bleeding persisted with every defe- cation so that she sought medical advice. After the hospitalization, and in order to find out the source of rectal bleeding, a plain abdominal X-ray was taken with an increase in bowel gas. There were abundant erythrocytes and some leucocytes observed in the stool examination. Stool culture for bacteria and stool clostridium difficile E. Ahishali Á O. Uygur-Bayramic ¸li (&) Á C. Dolapc ¸iog ˘lu Á A. Is ¸ik Á E. Ermis ¸ Department of Gastroenterology, Kartal State Hospital, No: 55/8 Bostanci, 34744 Istanbul, Turkey e-mail: oyabayramicli@yahoo.com.tr R. Dabak Department of Family Medicine, Kartal State Hospital, Istanbul, Turkey A. Mengi Department of Internal Medicine, Kartal State Hospital, Istanbul, Turkey 123 Dig Dis Sci (2009) 54:2541–2545 DOI 10.1007/s10620-008-0630-2