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Large bowel obstruction: an unusual presentation of salmonella enterocolitis in infancy
1Department of Pediatric Surgery, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.
Insights
A Salmonella enterocolitis infection caused a large-bowel obstruction in an infant, mimicking Hirschsprung's disease. Despite surgical intervention, the infant succumbed to severe gastroenteritis due to a persistent antibiotic-resistant Salmonella strain.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Gastroenterology
Background:
- Large-bowel obstruction in infants can present with symptoms mimicking congenital conditions like Hirschsprung's disease.
- Salmonella enterocolitis is a significant cause of pediatric gastrointestinal illness, with potential for severe complications.
Observation:
- An infant presented with clinical and radiologic findings suggestive of total colonic aganglionosis (Hirschsprung's disease).
- Initial surgical management included an ileostomy due to clinical deterioration.
- Pathologic examination revealed the presence of ganglia, ruling out Hirschsprung's disease.
Findings:
- The infant had Salmonella group B enterocolitis causing the obstruction.
- A subsequent resection of the obliterated colon and ileorectal anastomosis was performed.
- The patient became a carrier of a multidrug-resistant Salmonella strain.
Implications:
- This case highlights the importance of considering infectious etiologies in neonatal bowel obstruction.
- Multidrug-resistant Salmonella strains pose a significant threat in vulnerable infant populations.
- Prompt diagnosis and management are crucial, but complications from resistant pathogens can be fatal.
Abstract:
An infant with a large-bowel obstruction due to Salmonella B enterocolitis is presented. The clinical and radiologic findings were suggestive of Hirschsprung's disease with total colonic aganglionosis. Due to further deterioration, an ileostomy was performed. Pathologic examination disclosed ganglia in the colon. At laparatomy, 1 month later the colon, which was almost completely obliterated, was resected and an ileorectal anastomosis carried out. The patient remained a carrier of a multiple antibiotic-resistant group B Salmonella strain, and 2 months later died as a result of severe gastroenteritis.