Toxic dilatation of the colon in salmonella colitis and inflammatory bowel disease

Schofield, Philip F.; Mandal, B K; Ironside, A G

doi:10.1002/bjs.1800660104

Cited by 33 publications

(5 citation statements)

References 9 publications

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“…The endoscopic picture in such cases, as well as the histopathology, may be indistinguishable from mild to moderate UC (124). Severe isolated colitis (125,126) is uncommon, although toxic dilatation has been described relatively frequently in Salmonella colitis (127)(128)(129)(130)(131)(132). Salmonella colitis is usually of short duration; histopathology usually returns to normal within 1 month (1 33).…”

Section: Salmonella Speciesmentioning

confidence: 99%

Clinical evaluation and management of acute severe colitis

Blomberg

2007

Inflamm Bowel Dis

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Section: Salmonella Speciesmentioning

confidence: 99%

Clinical evaluation and management of acute severe colitis

Blomberg

2007

Inflamm Bowel Dis

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“…This is a rare complication nowadays, particularly in developed countries such as in Australia. Severe cases such as this have nonetheless been reported previously 1–4…”

Section: Discussionmentioning

confidence: 66%

An unusual case of caecal perforation following ileostomy reversal

Aksakal¹,

2019

BMJ Case Rep

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A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.

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“…29,30 Many salmonella species have been implicated in cases of both distal and proximal colonic disease, without any link between the pattern of involvement and the particular species. S. newport infection, which can cause either right-or left-sided colonic disease, usually has a good overall prognosis.…”

Section: Pathological Discussionmentioning

confidence: 99%

Case 16-2001

LaMont¹,

Graeme‐Cook²

2001

N Engl J Med

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A 17-year-old girl (gravida 1, para 1) was admitted to the hospital because of abdominal pain, fever, and diarrhea.The patient had been in good health before admission. Three weeks earlier, she had undergone a cesarean section because of multiple bouts of fetal bradycardia; the infant was delivered at 40 weeks of gestation. The pregnancy was otherwise uneventful. She received a single dose of gentamicin and two doses of clindamycin intravenously in the peripartum period. Her postpartum course was uneventful, and she was discharged on the third postoperative day.Three days before admission, the patient began to have pain in the right lower quadrant of her abdomen. The pain became more severe the next day and was accompanied by very frequent, watery stools that were brown and later black, nausea, and a temperature that peaked at 38.3°C. She passed no fresh blood. One day before admission, 2 liters of fluid with electrolytes was administered intravenously. On the day of admission, the pain became more severe and was unrelieved by acetaminophen-oxycodone, although the diarrhea had ceased.The patient did not have a history of previous abdominal pain or exposure to patients with gastroenteritis, and there was no family history of inflammatory bowel disease. She resided in eastern Massachusetts.The temperature was 38.7°C, the pulse was 104, and the respirations were 16. The blood pressure was 130/70 mm Hg.On examination, the patient was in considerable pain. Her abdomen was soft but exquisitely tender in the right lower quadrant, without rebound tenderness; bowel sounds were diminished. A stool specimen contained occult blood.The urine was normal; the sediment contained 0 to 2 red cells and 3 to 5 white cells per high-power field. The results of hematologic studies performed at various times during the hospital stay are shown in Table 1. Blood chemical values were normal. A computed tomographic (CT) scan of the abdomen and pelvis, obtained after the rectal administration of contrast material (Fig. 1), revealed concentric thickening of the wall of the cecum and proximal ascending colon, with fat stranding and prominent lymph nodes in the adjacent mesentery. A transabdominal and transvaginal ultrasonographic study of the pelvis showed no abnormalities.Morphine was given intravenously. A blood specimen and a rectal swab were obtained for culture. Ampicillin, gentamicin, and fluid and electrolytes were administered intravenously; heparin was injected subcutaneously, and metronidazole was given orally. Total parenteral nutrition was instituted. The temperature rose to 39.1°C on the first hospital day. The uterus was not tender; its size corresponded to a 12-week gestation; there was no discharge.On the second hospital day, the temperature rose to 38.8°C. Blood chemical tests were performed on this day and subsequently during the hospital course ( Table 2). An abdominal radiograph showed no abnormalities. The administration of analgesia, controlled by the patient, was begun. The pain improved briefly, but the patient refused...

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Toxic dilatation of the colon in salmonella colitis and inflammatory bowel disease

Cited by 33 publications

References 9 publications

Clinical evaluation and management of acute severe colitis

Clinical evaluation and management of acute severe colitis

An unusual case of caecal perforation following ileostomy reversal

Case 16-2001

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