West A B, Kuan S F, Bennick M, Lagarde S
Department of Pathology, Yale University, New Haven, Connecticut.
Gastroenterology. 1995 Apr;108(4):1250-5. doi: 10.1016/0016-5085(95)90227-9.
Although potentially noxious compounds are used routinely to disinfect endoscopes, reports of their inadvertent introduction to the gastrointestinal tract, usually attributed to the retention of disinfectant within endoscope channels, are rare. This case report describes the clinical features of glutaraldehyde-induced colitis and the pathology of the mucosal injury in four patients, in at least one of whom the disinfectant was not retained in the endoscope itself. Within 3 months, three patients experienced severe acute proctocolitis < 6 hours after a sigmoidoscopy showing no abnormalities, performed in a small endoscopy unit. Investigation of the unit's protocols suggested that the most likely cause was retention of 2% glutaraldehyde disinfectant in the endoscope channels, and changes were made to prevent this. When a fourth case occurred 5 months later, the source of the glutaraldehyde was found to be the tubing connecting water bottles to the endoscopes, which was disinfected rigorously but flushed inconsistently between cases. Glutaraldehyde-induced colitis seems similar to ischemic colitis in biopsy specimens and cannot be diagnosed by histological analysis alone. Acute colitis occurring within 24 hours of a colonoscopy showing no abnormalities should be considered iatrogenic and should lead to an investigation of procedures in use for cleaning and disinfecting endoscopic equipment.
尽管通常使用具有潜在毒性的化合物来对内窥镜进行消毒，但关于这些化合物意外进入胃肠道的报告却很罕见，这种情况通常归因于消毒剂滞留在内窥镜通道内。本病例报告描述了4例戊二醛诱发的结肠炎的临床特征以及黏膜损伤的病理情况，其中至少有1例患者的消毒剂并非滞留在内窥镜本身。在3个月内，3例患者在一家小型内窥镜检查单位进行乙状结肠镜检查且未发现异常后的6小时内，出现了严重的急性直肠结肠炎。对该单位操作流程的调查表明，最可能的原因是2%戊二醛消毒剂滞留在内窥镜通道内，随后做出了改进以防止这种情况发生。5个月后发生第4例病例时，发现戊二醛的来源是连接水瓶与内窥镜的管道，该管道经过严格消毒，但不同病例之间冲洗不一致。戊二醛诱发的结肠炎在活检标本中似乎与缺血性结肠炎相似，不能仅通过组织学分析来诊断。在结肠镜检查未发现异常后的24小时内发生的急性结肠炎应被视为医源性的，并且应该对用于清洁和消毒内窥镜设备的操作进行调查。
