Mahapatra Sidharth, Michie Sara A, Sylvester Karl, Cornfield David
Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Pathology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
J Investig Med High Impact Case Rep. 2016 Mar 17;4(1):2324709616638698. doi: 10.1177/2324709616638698. eCollection 2016 Jan-Mar.
Although diarrhea is the most commonly reported pediatric illness in the United States, mortality is usually a rare and unexpected event. We report the case of a healthy 13-month-old male that succumbed to a diarrheal illness of unclear etiology. Presenting signs included frequent nonbloody stools that progressed to frankly bloody stools over 72 hours. Associated symptoms included fever, tenesmus, relief with stool passage, and significant fatigue. On examination, the patient appeared tired and lay with legs curled toward his chest. The abdominal exam was remarkable for hypoactive bowel sounds, diffuse tenderness to palpation without guarding or rebound pain, and intermittent prolapse of rectal tissue. Abdominal plain films demonstrated a paucity of bowel gas, especially in the rectum; and ultrasound revealed thickening of bowel loops in the left lower quadrant. Abdominal computed tomography scan showed decreased enhancement of the mucosa of the rectosigmoid colon. The patient deteriorated rapidly with cardiorespiratory arrest occurring 48 hours after admission. Despite a protracted effort at cardiopulmonary resuscitation, perfusing heart rate or rhythm could not be reestablished. Autopsy revealed infarction and necrosis of the rectosigmoid colon with invasive gram-negative bacilli. Here we present his perplexing case, diagnostic evaluations, and suggest a unifying diagnosis.
尽管腹泻是美国报告的最常见儿科疾病，但死亡通常是罕见且出乎意料的事件。我们报告了一例病因不明的腹泻病导致死亡的13个月大健康男婴病例。呈现的症状包括频繁的非血性粪便，在72小时内进展为明显的血性粪便。相关症状包括发热、里急后重、排便后缓解以及明显疲劳。检查时，患者显得疲倦，双腿蜷缩向胸部躺着。腹部检查显示肠鸣音减弱，触诊时有弥漫性压痛但无肌卫或反跳痛，直肠组织间歇性脱垂。腹部平片显示肠气减少，尤其是直肠；超声显示左下腹肠袢增厚。腹部计算机断层扫描显示直肠乙状结肠黏膜强化减弱。患者入院48小时后出现心肺骤停，病情迅速恶化。尽管进行了长时间的心肺复苏努力，但未能恢复灌注性心率或心律。尸检显示直肠乙状结肠梗死和坏死，伴有侵袭性革兰氏阴性杆菌。在此我们呈现他这一令人困惑的病例、诊断评估，并提出一个统一的诊断。
