International Journal of Colorectal Disease

, Volume 17, Issue 4, pp 275–279

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

Authors

  •  A. Chaudhuri
    • Department of General Surgery, Hinchingbrooke Hospital, Huntingdon PE29 6NS, UK
  •  B. Bekdash
    • Department of General Surgery, Hinchingbrooke Hospital, Huntingdon PE29 6NS, UK
Case Report

DOI: 10.1007/s00384-001-0374-3

Cite this article as:
Chaudhuri, A. & Bekdash, B. Int J Colorectal Dis (2002) 17: 275. doi:10.1007/s00384-001-0374-3

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 Salmonellaenteritidis 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.

Salmonella Toxic megacolon
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© Springer-Verlag 2001