Ewha Med J.  2017 Jan;40(1):50-54. 10.12771/emj.2017.40.1.50.

Bisacodyl Induced Severe Rectal Ulcer with Proctitis

• Cho HJ
• Shin JU
• Jin SS
• Kang HJ
• Jeon HW
• Lee JY

• KMID: 2367897
• DOI: http://doi.org/10.12771/emj.2017.40.1.50

Abstract

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.

Keyword

Bisacodyl; Constipation; Proctitis; Ulcer; Rectum

MeSH Terms

Abdominal Pain
Administration, Rectal
Adult
Aged, 80 and over
Bisacodyl*
Child
Colitis
Constipation
Diarrhea
Female
Gastrointestinal Motility
Humans
Mucous Membrane
Proctitis*
Rectum
Ulcer*
Bisacodyl

Figure

• 

  Fig. 1 Initial sigmoidoscopy findings in the rectum. A large round ulcer was seen at the distal rectum ((A) anal verge 5 cm to 10 cm to dentate line) and another large ulcer with an irregular margin at the distal rectum ((B) anal verge 3 cm to dentate line). Complete healing of the rectal ulcers was seen at the follow-up sigmoidoscopy 8 weeks later ((C) mid rectum, (D) distal rectum).

• 

  Fig. 2 Histological features of the rectum. (A, B) The lesion is ulcerated with an infiltration of neutrophils and lymphoplasma cells in the lamina propria. The adjacent mucosa shows no collagen deposition, smooth muscle proliferation, or distortion of crypt architecture (H&E, ×100).

• 

  Fig. 3 Abdominal computed tomography scan. (A, C) This shows diffuse segmental wall thickening at the rectum with mild perirectal engorgement and luminal dilatation (white arrows). (B, D) There was no abnormal wall thickening in other parts of the colon.

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