Proctocolitis or TikTok‐olitis: The dangers of social media influence on home constipation management

We report a case of proctocolitis from self-administration of a hydrogen peroxide (H2O2) enema. A 17-year-old female with irritable bowel syndrome-constipation type reported abdominal pain and dyschezia. Based on a TikTok remedy, she filled an enema bag with water and a quarter cup of 12% H2O2, and administered per rectum, resulting in severe abdominal pain and bloody stools. Upon emergency room presentation, she had a non-distended abdomen with diffuse lower quadrant tenderness. Computed tomography (CT) abdomen revealed colonic pneumatosis, portal venous air, and thickening of the rectosigmoid colon (Figure 1), presumably from chemical colitis. She was admitted and managed conservatively with nothing by mouth (NPO), intravenous fluids, and antibiotics (ciprofloxacin and metronidazole). After 72 h, her exam improved, and her imaging normalized. Flexible sigmoidoscopy on Day 5 revealed rectal erythema, edema, and normal sigmoid colon (Figure 2). No biopsies were taken. She was discharged with oral antibiotics and counseled on appropriate constipation management. H2O2 produces reactive oxygen species and lipid peroxidation, which destroys cell membranes. Higher transmural pressure can impair mucosal perfusion.1, 2 Few pediatric cases of chemical proctocolitis from H2O2 enemas are described with imaging demonstrating mucosal thickening without pneumatosis.3, 4 In these cases, NPO and intravenous fluids were given for 1–3 days, and all recovered uneventfully. Treatment with steroids, antibiotics, rectal mesalamine, and even hyperbaric oxygen in the setting of gas embolism have been utilized in adult patients.5-7 This case illustrates social media's risk of misleading adolescents into harmful health decisions, highlighting the need for improved public health and medical education. The authors declare no conflicts of interest. Informed verbal patient and parent consent was obtained prior to before submission of this case report/case image.