Naval Medical Center Portsmouth, Department of Pediatrics, 620 John Paul Jones Cir, Portsmouth, VA 23708.
Pediatrics. 2014 Jan;133(1):e235-9. doi: 10.1542/peds.2012-2963. Epub 2013 Dec 23.
Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient's illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians' indices of suspicion for uncommon complications of common procedures.
功能性便秘是一种常见的儿科问题，通常通过成熟的算法进行治疗。粪便排净是初始的治疗步骤，严重的病例需要住院进行强化治疗。我们描述了这种常见临床情况的一个显著意外并发症。一名 8 岁男孩因疑似慢性功能性便秘而住院，通过连续鼻胃管给予聚乙二醇电解质（PEG-E）溶液进行排净。在排净的第六天，患者突然出现发热、心动过速和呼吸急促。评估包括血培养，培养出大肠杆菌，并给予适当抗生素疗程治疗。PEG-E 溶液在便秘儿童的研究中已被证明是安全的，这使得该患者的疾病令人惊讶。考虑了他感染的几个潜在病因，包括细菌易位（BT）。BT 定义为活微生物和微生物产物从胃肠道转移到肠外部位，如血液。它已在多种临床情况下被证明存在，但临床意义尚不清楚。在这种情况下，肠黏膜的物理损伤被认为促成了 BT 的潜在发生，而长时间的排净被认为是一个危险因素。在接受 PEG-E 鼻胃管粪便排净的住院患儿中，大肠杆菌败血症是文献中从未报道过的临床问题，应增加临床医生对常见操作罕见并发症的怀疑指数。
