Bubble Trouble: Portal Venous Gas Embolism Following Hydrogen Peroxide Enema.

Hydrogen peroxide (H2O2) is a caustic agent capable of causing serious gastrointestinal injury, yet its use as an enema is promoted in some alternative medicine communities for constipation. We report a case of a 56-year-old man who developed portal and mesenteric venous air embolism and chemical colitis following self-administration of an H2O2 enema. Imaging revealed extensive portal venous gas and colitis. Colonoscopy confirmed diffuse mucosal injury, and biopsies showed acute colitis with ulceration. The patient was treated with intravenous fluids, broad-spectrum antibiotics, and hyperbaric oxygen therapy, resulting in resolution of gas embolism. This case highlights the dangers of H2O2 enemas and the potential role of hyperbaric therapy in management.