Lacerations of the mucosa and submucosal structures of the rectum following the insertion of enema tips, thermometers, and, occasionally, of suppositories occur more commonly than is universally recognized. Superficial lacerations of the anterior surface of the rectal mucosa are frequently observed in patients who are instructed to take cleansing enemas preliminary to endoscopy. These lacerations occur even when the preparatory enemas are given by trained personnel, including nurses. As a rule, these injuries heal spontaneously without incident unless preexisting rectal inflammatory disease or infection in the anal crypts or ducts exists. Occasionally, considerable bleeding occurs that requires urgent attention. In the past, because of failure of conservative forms of therapy, I have had to perform a hemorrhoidectomy because of persistent bleeding from a laceration into a hemorrhoidal varix that was produced by an enema tip in a patient who took enemas often. In another similar situation, packing with thrombinsoaked absorbable
Turell R. SIMPLIFIED TREATMENT OF LACERATIONS OF THE RECTUM. JAMA. 1953;152(2):136–137. doi:10.1001/jama.1953.63690020010004e
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