Cho Joon Hyun
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Medicine (Baltimore). 2019 Aug;98(31):e16521. doi: 10.1097/MD.0000000000016521.
Massive intestinal bleeding as a complication of typhoid fever has rarely been reported due to the advent of antibiotics. In addition, although several literatures have been issued on the use and success of endoscopic modalities in cases of massive typhoid ulcer bleeding, few have described hemostasis by endoscopic hemoclipping.
We describe a case of a 61-year-old Korean female who presented acute episodes of massive lower gastrointestinal bleeding during admission to local hospital with a provisional diagnosis of acute gastroenteritis. She had returned from a trip to Southeast Asia 3 weeks prior to admission DIAGNOSES:: After the result of blood culture was identified as Salmonella typhi, we could make a diagnosis of typhoid fever complicated by massive intestinal bleeding and acute pancreatitis based on elevated serum lipase and computerized tomography (CT) findings.
The patient was treated successfully by two repeat colonoscopic hemostasis procedures involving the deployment of hemoclips on ulcers in the terminal ileum and 10-day course of intravenous ciprofloxacin OUTCOMES:: The patient was stable and reported no further episodes of intestinal bleeding or fever during the follow-up time. In addition, acute pancreatitis, which is a rare complication of typhoid fever, resolved without complication on follow-up CT and a laboratory study.
Considering the risk of procedure-related complications such as perforation of the small intestine wall, which become thin and friable due to ulceration, mechanical hemostasis methods, such as hemoclipping, might be safer than coagulation, when the bleeding spot can be identified and is not multiple, as in our case. In addition, our case demonstrates that S. typhi should be considered in the differential diagnosis of massive lower gastrointestinal hemorrhage, especially in the setting of recent travel in South or Southeast Asia.
由于抗生素的出现，伤寒热并发症导致的大量肠道出血鲜有报道。此外，尽管已有多篇关于内镜治疗在大量伤寒溃疡出血病例中的应用及成功案例的文献，但很少有描述内镜下止血夹止血的情况。
我们描述了一名61岁的韩国女性病例，她因初步诊断为急性肠胃炎入住当地医院时出现急性大量下消化道出血。她在入院前3周从东南亚旅行归来。
血培养结果确诊为伤寒杆菌后，根据血清脂肪酶升高及计算机断层扫描（CT）结果，我们诊断为伤寒热并发大量肠道出血和急性胰腺炎。
患者通过两次重复结肠镜止血程序成功治疗，包括在回肠末端溃疡处部署止血夹，并静脉注射环丙沙星10天。
患者病情稳定，在随访期间未再出现肠道出血或发热。此外，伤寒热罕见并发症急性胰腺炎在随访CT及实验室检查中无并发症地得到缓解。
考虑到与手术相关的并发症风险，如小肠壁因溃疡而变薄变脆导致穿孔，当出血点可识别且非多处时，如我们的病例，机械止血方法如止血夹止血可能比凝血更安全。此外，我们的病例表明，在大量下消化道出血的鉴别诊断中应考虑伤寒杆菌，特别是在近期有南亚或东南亚旅行史的情况下。
