Toxic megacolon due to Salmonella: a case report and review of the literature.
OBJECTIVE
Salmonella colitis is an unusual cause of toxic megacolon. We provide an overview of this condition and report a single case.


METHODS
A 62-year-old man underwent subtotal colectomy with ileostomy formation for toxic megacolon due to Salmonella enteritidis 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.


CONCLUSIONS
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.
Chaudhuri
A
A
Department of General Surgery, Hinchingbrooke Hospital, Huntingdon PE29 6NS, UK. arindam@chaudhuri.freeserve.co.uk
Bekdash
B A
BA
D006801:Humans; D008297:Male; D008532:Megacolon, Toxic / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D012480:Salmonella Infections / Q000453:epidemiology* / Q000601:surgery; D012477:Salmonella enteritidis