The subject of injury to the anorectum and colon has been lucidly described and discussed by Bowers.1 It has been appreciated for some time that injuries incident to enemas may be either mechanical (physical) or chemical in character, or both. The mechanism of injury may vary from insignificant erythema of the lining of the anal canal or the intestinal mucosa to perforation of the rectum.2-4 The mechanism of perforation has also been well described.
In recent years, since the introduction of concentrated enemas in disposable containers, an additional factor has been added, namely, the employment of hypertonic solutions of such substances as sodium phosphate and biphosphate. These chemicals apparently have the potential or propensity to exert a profound chemical effect on raw surfaces such as lacerations, thus compounding the results of the physical injury.
Clinical Experiment and Experience
A number of years ago I examined the anorectums of
TURELL R. Laceration to Anorectum Incident to EnemaTherapeutic Considerations. Arch Surg. 1960;81(6):953-954. doi:10.1001/archsurg.1960.01300060099018