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Endoscopy 2007; 39(10): 916-919
DOI: 10.1055/s-2007-966652
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Hydrogen peroxide-related colitis (previously known as ”pseudolipomatosis“): a series of cases occurring in an epidemic pattern

G.  Cammarota1 , P.  Cesaro1 , A.  Cazzato1 , P.  Fedeli1 , M.  E.  Riccioni2 , L.  Sparano1 , G.  Vitale1 , G.  Costamagna2 , G.  Gasbarrini1 , L.  M.  Larocca3
  • 1Department of Internal Medicine and Gastroenterology, ”A. Gemelli” University Hospital of Rome, Rome, Italy
  • 2Department of Surgical Digestive Endoscopy, ”A. Gemelli” University Hospital of Rome, Rome, Italy
  • 3Institute of Pathology, ”A. Gemelli” University Hospital of Rome, Rome, Italy
Further Information

Publication History

submitted 29 April 2007

accepted after revision 7 May 2007

Publication Date:
02 August 2007 (online)

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We report several cases of hydrogen peroxide-related colitis that occurred in an epidemic pattern in our gastrointestinal endoscopy center during a 2-month period in early 2007. During colonscopy using sterilized endoscopes that had been flushed with hydrogen peroxide after the peracetic acid cycle, instantaneous effervescence and blanching (the ”snow white sign“) were observed on the intestinal mucosa when the water button was depressed. Biopsy specimens revealed features resembling a clinical condition which used to be known as ”pseudolipomatosis.“ At follow-up, no patient was found to have suffered morbidity associated with this peroxide colitis. Endoscopists should consider hydrogen peroxide colitis when they see a snow white sign during colonoscopy which cannot be attributed to active inflammation or organic disease of the digestive tract.

References

  • 1 Snover D C, Sandstad J, Hutton S. Mucosal pseudolipomatosis of the colon.  Am J Clin Pathol. 1985;  84 575-580
    PubMedGoogle Scholar
  • 2 Brevet M, Chatelain D, Bartoli E. et al . Colonic pseudolipomatosis: clinical, endoscopical and pathological features in nine cases.  Gastroenterol Clin Biol. 2006;  30 9-16
    PubMedGoogle Scholar
  • 3 Lapeyre B. The ”frost sign” and the ”snow white sign”: intramucosal air injection or peroxide colitis?.  Endoscopy. 2005;  37 679
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Bilotta J J, Waye J D. Hydrogen peroxide enteritis: the ”snow white” sign.  Gastrointest Endosc. 1989;  35 428-430
    PubMedGoogle Scholar
  • 5 Ben Rejeb A, Khedhiri F. Mucosal pseudolipomatosis of the colon: apropos of a case with a review of the literature.  Arch Anat Cytol Pathol. 1989;  37 254-257
    PubMedGoogle Scholar
  • 6 Waring J P, Manne R K, Wadas D D. et al . Mucosal pseudolipomatosis: an air pressure-related colonoscopy complication.  Gastrointest Endosc. 1989;  35 93-94
    CrossrefPubMedGoogle Scholar
  • 7 Jonas G, Mahonas A, Murray J. et al . Chemical colitis due to endoscope cleaning solutions: a mimic of pseudomembranous colitis.  Gastroenterology. 1988;  95 1403-1408
    PubMedGoogle Scholar
  • 8 Ryan C K, Potter G D. Disinfectant colitis: rinse as well as you wash.  J Clin Gastroenterol. 1995;  21 6-9
    PubMedGoogle Scholar
  • 9 Meyer C T, Brand M, de Luca V A. et al . Hydrogen peroxide colitis: a report of three patients.  J Clin Gastroenterol. 1981;  3 31-35
    PubMedGoogle Scholar
  • 10 Coton T, Bohand X, Guisset M. et al . Acute colitis induced by a peracetic acid-based solution used to disinfect endoscopes.  Gastroenterol Clin Biol. 2003;  27 556-558
    PubMedGoogle Scholar

G. Cammarota, MD

Istituto di Medicina Interna

Policlinico Universitario ”A. Gemelli”

Largo A. Gemelli 8

Rome 00168

Italy

Fax: +39-06-35502775

Email: gcammarota@rm.unicatt.it

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