Exposure of the gastrointestinal mucosa to the chemical used to disinfect an endoscope can result in a chemical colitis.
Chemical disinfectants:
(1) hydrogen peroxide
(2) glutaraldehyde
Clinical features:
(1) The onset of colitis within 48 hours after a colonoscopy.
(2) The diagnosis is supported if the previous colonoscopy was normal or showed a process other than colitis. If the previous colonoscopy showed colitis then the diagnosis may be difficult.
(3) If hydrogen peroxide is involved, the endoscopist may notice the "snow white" sign soon after starting the procedure. This occurs when hydrogen peroxide bubbles on the mucosal surface.
(4) A problem is detected in the processing of the endoscope which would allow the disinfectant to be released into the bowel lumen (failure of wash cycle, mixup in containers, etc)
(5) Other types of colitis have been excluded.
Since Clostridium difficile has spores and spores are resistant to cleaning, it is important to make sure that Clostridium difficile is specifically excluded.
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