Salmonella enterocolitis and hemorrhagic shock - 22/08/11
Doi : 10.1016/j.gie.2006.09.024
| Commentary Hematochezia in a cirrhotic individual prompts the clinician to exclude complications of portal hypertension, such as portal colopathy, gastropathy, and enteropathy, and to consider hemosuccus pancreaticus, ischemic colitis (mainly transverse colon and splenic flexure), impaired coagulation, and thrombocytopenia, as well as infections, eg, Yersinia. Little did Daniel Elmer Salmon know when he sole-authored a paper on the cause of hog cholera (Salmonella cholerasuis), actually discovered by his second-in-command, Theobald Smith, that the infection later to bear his name would become one of most commonly documented bacterial causes of diarrhea in developed nations. Colonoscopy rarely enables determination of the specific cause for acute diarrhea; is diagnostically more useful in cases of bloody diarrhea; and is most valuable, as in this case, to differentiate acute from chronic colitis. Acute (infectious) colitis was suggested by the predominance of neutrophils throughout the lamina propria and the straight colon glands without architectural distortion. The take-home message: don’t neglect the stool culture; distasteful to some, it is cheap and, when diagnostic, it is indispensable. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 65 - N° 7
P. 1077-1078 - juin 2007 Retour au numéro
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