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Small bowel mucormycosis: An unexpected case in a penetrating trauma survivor
Malini Bhana1, Naadiyah Laher1, Nathan George McGrath2
1Division of Trauma, Department of General Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 5 Jubilee Street, Parktown, Johannesburg, South Africa.
Introduction:
Small bowel mucormycosis is a rare entity with few reports in the literature. Mortality rates secondary to necrosis and perforation remain above 85 %, with an increase in populations at risk noted.
Presentation Of Case:
This is a case report of a survivor of penetrating trauma who sustained small bowel injuries and was managed with damage control surgery. He required relook laparotomies due to extensive contamination and subsequently developed progressive ischaemia and necrosis of areas of his small bowel - histology confirming mucormycosis. There were no apparent risk factors noted in this case. Early addition of Amphotericin B and prompt surgical management resulted in a positive outcome. The patient was discharged from the hospital successfully. No further complications were noted post-discharge.
Discussion:
Small bowel mucormycosis can be a challenging diagnosis and requires a high index of suspicion. The lack of traditional risk factors should not deter a surgeon from considering this diagnosis in trauma patients as the micro-invasive properties of this organism can result in unexpected gastrointestinal ischaemia. Favourable outcomes are associated with prompt surgical debridement, histopathological diagnosis, and appropriate antifungal therapy.
Conclusion:
Gastrointestinal Mucormycosis is a diagnosis that should be considered in trauma patients with unusual patterns of ischaemia. Prompt therapy can result in positive outcomes.
Insights
Small bowel mucormycosis is a rare fungal infection. Prompt surgical intervention and antifungal therapy are crucial for positive outcomes in trauma patients, even without typical risk factors.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Small bowel mucormycosis is a rare condition with high mortality.
- Risk factors are not always apparent, especially in trauma patients.
Observation:
- A trauma patient developed small bowel ischemia and necrosis post-surgery.
- Histopathology confirmed mucormycosis despite the absence of typical risk factors.
Findings:
- Early diagnosis and treatment with Amphotericin B and surgical debridement led to a positive outcome.
- Mucormycosis can cause unexpected gastrointestinal ischemia in trauma settings.
Implications:
- A high index of suspicion is necessary for diagnosing small bowel mucormycosis in trauma patients.
- Prompt surgical and antifungal management can improve outcomes in this challenging condition.
