Death Following Injection Sclerotherapy Due to Phenol Toxicity

Abstract

Prolapse rectum (PR) or protrusion of the rectum beyond the anus occurs frequently in populations at both extremes of age. In the pediatric population, in developed countries, the commonest cause for PR is thought to be cystic fibrosis (CF). Treatment options for CF include conservative management, surgical resection and fixation, suturing, and injection sclerotherapy (IS). The last is considered an attractive treatment option because it is minimally invasive. In this case report, the authors present the details about a 2-year-old female child, with PR and CF, who died after IS, using phenol as the sclerotherapeutic agent. Autopsy findings and toxicology tests performed to establish phenol toxicity are documented. The available literature is reviewed. This case report underscores the risks of using phenol for IS and emphasizes the point that the procedure is not innocuous and an adverse outcome including fatality is a possibility.

Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure

“…A procedure with no recurrence but with complications is Ekehorn's rectosacropexy, with an 80% infection rate [24,25]. On the other hand, methods without complications but with significant recurrence frequency are sclerotherapy with a 5%-71% rate [21,[26][27][28][29][30][31], anal cerclage with 80% [26], and posterior sagittal rectopexy with 6%-70% [19][20][21]. There is one reported mortality case after sclerotherapy with phenol [27].…”

“…On the other hand, methods without complications but with significant recurrence frequency are sclerotherapy with a 5%-71% rate [21,[26][27][28][29][30][31], anal cerclage with 80% [26], and posterior sagittal rectopexy with 6%-70% [19][20][21]. There is one reported mortality case after sclerotherapy with phenol [27]. Three authors have reported complications and recurrences with linear cauterization [32], Thiersch's technique [26], and Lockhart-Mummery technique [11,33].…”

Pediatric Colorectal Disorders

“…Ethanol 70% injected results in resolution of 96% of cases after one injection and 98% of cases after two injections [68]. There were few complications seen in these studies including temporary fecal incontinence, temporary limping, bleeding, perirectal inflammation, urinary retention, necrosis of the rectal mucosa, and abscess formation and one death after the injection of phenol [65][66][67][68][69].…”