Toxic megacolon due to Salmonella: a case report and review of the literature.

Abstract

BACKGROUND AND AIMS:

Salmonella colitis is an unusual cause of toxic megacolon. We provide an overview of this condition and report a single case.

PATIENTS AND METHODS:

A 62-year-old man underwent subtotal colectomy with ileostomy formation for toxic megacolon due to Salmonella enteritidis phage type 4 colitis, followed by reversal with an ileorectal anastomosis.

RESULTS:

Twenty-seven cases have been described in the literature. These were first treated conservatively, with antibiotics and systemic/local steroids, and some proceded to surgery.

CONCLUSION:

Salmonella is a rare cause of toxic megacolon, but it can behave opportunistically in patients with ulcerative colitis. S. enteritidis phage type 4 is typically transmitted via raw or uncooked eggs in most cases of salmonellosis attributed to this organism. The disease is rapidly progressive, and death may ensue due to septicaemia and/or perforation. Toxic megacolon is treated aggressively, initially medically, with high-dose steroids and attention to fluid balance, ulcerative colitis being the usual working diagnosis. Once Salmonella is cultured, appropriate antibiotics are commenced. Non-surgical decompression may be appropriate in some cases, but early surgical intervention is required for failed response to these measures or rapid deterioration in the patient's condition. Following initial surgery - often subtotal colectomy and ileostomy formation - continuity may be restored. For most patients with ulcerative colitis ileal pouch anal anastomosis is the operation of choice, but ileorectal anastomosis may be safely performed for Salmonella-induced toxic megacolon. Prevention is better than cure, and therefore health education needs to reinforce avoidance of use of raw or uncooked eggs.

• Authors: A Chaudhuri, B A Bekdash
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 17 Issue 4 Pg. 275-9 (Jul 2002) ISSN: 0179-1958 [Print] Germany
• PMID: 12073077 (Publication Type: Case Reports, Journal Article, Review)

Topics

• Humans
• Male
• Megacolon, Toxic (epidemiology, microbiology, surgery)
• Middle Aged
• Salmonella Infections (epidemiology, surgery)
• Salmonella enteritidis