Introduction

Ethanol is commonly consumed orally, and some rare reports describe the rectal administration of ethanol, which can lead to significant gastrointestinal and systemic toxicity. The first step of ethanol metabolism is by the liver through first-pass hepatic metabolism. Enemas allow for rapid mucosal absorption of alcohol, which bypasses this first step and leads to elevated systemic blood alcohol concentrations, which can cause toxicity [1]. The clinical presentation typically includes abdominal pain, hematochezia, and profuse diarrhea [1]. Endoscopies of these reported cases show evidence of proctitis or colitis [1]. Case reports describe findings mimicking ischemic colitis on CT imaging. Endoscopy typically shows chemical-induced colitis with mucosal erosions [1-3]. Most cases resolve with conservative management, but complications like hemorrhage, metabolic derangements, and death have been reported [4-6]. Ethanol-induced colitis is an uncommon but important etiology in differentiating acute colitis. To the best of our knowledge, after a review of the published literature, no previous case has described concurrent intentional acetaminophen overdose and rectal ethanol administration. Previously reported cases have involved isolated ethanol enemas without concomitant toxic ingestions. A literature search of PubMed and Google Scholar using the terms "ethanol enema," "alcohol enema," "rectal ethanol," "chemical colitis," and "acetaminophen overdose" identified published reports of ethanol enemas but no prior reports describing simultaneous acetaminophen overdose. We present the unique case of a suicide attempt involving both intentional acetaminophen overdose and self-administered ethanol enema.