Severe ethanol-induced chemical proctitis with prolonged rectal bleeding:a case report

Chemical proctitis is an uncommon colorectal injury caused by direct mucosal exposure to irritant or caustic substances. Rectal ethanol exposure is particularly rare and may cause severe inflammation, ulceration, necrosis, and hemorrhage. We present a 60-year-old woman with constipation who self-administered an unknown volume of approximately 50% homemade ethanol-based beverage (rakia) into the rectum using a syringe, believing that it would relieve constipation. Within several hours, she developed severe abdominal pain, tenesmus, and bright-red rectal bleeding and was admitted to a local hospital without endoscopic facilities. Her hemoglobin concentration at admission was 85 g/L, and she received two units of blood. She remained hospitalized for seven days without specific pharmacological treatment, while the bleeding gradually subsided and had ceased by day 7. After referral, a complete colonoscopy showed normal mucosa throughout the colon proximal to the rectum. The rectum demonstrated marked erythema and edema, loss of the normal vascular pattern, irregular superficial ulceration, and focal fibrinous or necrotic-appearing areas, without active bleeding. Histopathology showed lamina propria edema, lymphocytic and plasmacytic infiltration, macrophages, congested capillaries, and necrotic areas, supporting acute chemical mucosal injury. Follow-up sigmoidoscopy on day 14 showed normalization of the rectal mucosa. This case demonstrates that intrarectal exposure to high-concentration ethanol may produce severe, transfusion-requiring rectal bleeding despite subsequent rapid mucosal recovery. A directed history of rectal exposure and careful endoscopic evaluation are important for distinguishing chemical proctitis from ischemic, inflammatory, and infectious causes.
Keywords: chemical proctitis; ethanol; rectal bleeding; colonoscopy; case report