PDF(Pubmed)
Abstract：
Enteric fever is a systemic bacterial infection caused by enteroinvasive, gram-negative bacilli, named Salmonella enterica serovar typhi and Salmonella enterica serovar paratyphi. It presents with hectic fever, headache, malaise, bowel habit changes, and abdominal pain. Diagnosis is usually confirmed by blood culture. Gastrointestinal complications of enteric fever include intestinal bleeding, bowel perforation, pancreatitis, and cholecystitis. We encountered a case of lower gastrointestinal bleeding (hematochezia) as a complication of enteric fever. A 35-year-old male patient presented to Aster CMI hospital, India, with an intermittent fever of 2-week duration associated with dry cough, loss of appetite, abdominal pain, and generalized body weakness. Four days after admission, he experienced three episodes of lower gastrointestinal bleeding. Upon physical examination, he was hemodynamically stable and had a high-grade fever, mild hepatomegaly, tipped splenomegaly, and lower abdominal tenderness. Blood culture grew Salmonella typhi. Abdominal ultrasound showed ileocolonic thickening with enlarged mesenteric lymph nodes. Abdominal computed tomography scan displayed enlarged mesenteric lymph nodes with surrounding fat strands. A colonoscopy revealed multiple shallow, punched-out, and punctate ileocolonic ulcerative lesions, with stigmata of active bleeding at caecal ulcers. Colonoscopy-guided biopsy suggested multifocal active colitis favoring infective etiology. Diagnosis of blood culture-confirmed enteric ulcer was made. He was treated with ceftriaxone 1 g iv twice daily for 10 days and rehydrated with intravenous fluids. Adrenaline injection was done at the site of bleeding ulcers, and hemostasis was secured. Other additional medications were antipyretics, anti-emetics, multivitamins, and proton pump inhibitors. He was fever-free on the third day of admission and discharged after 10 days of hospital stay. He was appointed to follow-up clinic after a week. He was completely healthy on the day of the first follow-up clinic visit and planned to resume his duties. Enteric fever remains a common public health problem in most developing countries. Early suspicion and prompt institution of appropriate antibiotics are crucial in the reduction of systemic and local complications of enteric fever. Since gastrointestinal complications of enteric fever are less often encountered in the antibiotic era, clinicians should be cognizant of an enteric ulcer as a cause of lower gastrointestinal bleeding.
摘要：
肠道热是由肠道侵入性引起的全身性细菌感染，革兰氏阴性杆菌,命名为伤寒沙门氏菌和伤寒沙门氏菌。它表现出狂热的发烧，头痛,萎靡不振,排便习惯改变,和腹痛。诊断通常通过血培养证实。肠热的胃肠道并发症包括肠出血，肠穿孔,胰腺炎,和胆囊炎.我们遇到一例下消化道出血（便血）作为肠热的并发症。一名35岁的男性患者被送往AsterCMI医院，印度,与干咳相关的2周间歇性发热，食欲不振,腹痛,和全身无力。入院四天后，他经历了三次下消化道出血。在体检时,他血流动力学稳定，发高烧，轻度肝肿大,脾肿大，和下腹部压痛。血培养培养伤寒沙门氏菌。腹部超声显示回肠结肠增厚伴肠系膜淋巴结肿大。腹部计算机断层扫描显示肠系膜淋巴结肿大，周围有脂肪束。结肠镜检查显示多个浅层，打孔，和点状回肠结肠溃疡性病变，盲肠溃疡有活动性出血的柱头。结肠镜引导活检提示多灶性活动性结肠炎有利于感染性病因。诊断为血培养证实的肠溃疡。他每天两次静脉注射头孢曲松1g治疗10天，并用静脉输液补水。在出血性溃疡部位注射肾上腺素,止血是安全的。其他额外的药物是退烧药，抗催吐剂,多种维生素,和质子泵抑制剂.入院第三天无发热，住院10天后出院。一周后，他被任命为随访诊所。在第一次随访诊所访问的当天，他完全健康，并计划恢复他的职责。在大多数发展中国家，肠道热仍然是一个常见的公共卫生问题。早期怀疑和及时使用适当的抗生素对于减少肠道热的全身和局部并发症至关重要。由于肠道热的胃肠道并发症在抗生素时代很少遇到，临床医生应认识到肠溃疡是下消化道出血的一个原因.
