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Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis
N A Ajayi1, S Marven, R O Kaschula
1Department of Paediatric Surgery Institute of Child Health, Red Cross Children's Hospital, Rondebosch 7700, Cape Town, South Africa.
Insights
Congenital syphilis (CS) can cause rare intestinal issues. This case shows an infant with obstruction and bleeding due to syphilitic ileitis, successfully treated with surgery.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Congenital syphilis (CS) is a multisystemic infection in newborns.
- Intestinal complications like obstruction and bleeding are rare in CS.
- Early diagnosis and treatment are crucial for preventing severe outcomes.
Observation:
- A VDRL-positive infant presented with symptoms of incomplete intestinal obstruction and rectal bleeding.
- Conservative management failed to alleviate the infant's persistent symptoms.
- Surgical exploration revealed inflammation and stenosis in the terminal ileum.
Findings:
- Histopathology confirmed syphilitic ileitis, characterized by plasmacytic infiltration and mucosal ulceration.
- The infant underwent ileal resection and anastomosis, leading to symptom resolution.
- This case is the first to document ileal ulcer bleeding associated with intestinal obstruction in CS.
Implications:
- Highlights an unusual presentation of congenital syphilis.
- Underscores the importance of considering CS in infants with gastrointestinal symptoms.
- Suggests surgical intervention may be necessary for severe intestinal complications of CS.
Abstract:
Intestinal obstruction and bleeding are uncommon complications of congenital syphilis (CS). A VDRL-positive infant developed incomplete intestinal obstruction and rectal bleeding. Despite conservative management, his symptoms continued. At laparotomy, terminal ileal inflammation and stenosis were demonstrated. He underwent ileal resection and primary end-to-end anastomosis with resolution of his symptoms. Histopathological examination demonstrated heavy plasmacytic infiltration of the lamina propria and submucosa with ulceration of the mucosa, consistent with syphilitic ileitis. This report documents for the first time bleeding from ileal ulcers associated with intestinal obstruction in CS and highlights an unusual presentation of the disease.