Phlegmonous colitis: another source of sepsis in cirrhotic patients?
BACKGROUND
The clinical relevance of phlegmonous colitis (PC), a rare autopsy finding in cirrhotic patients, is poorly documented. We postulated that PC might be a source of sepsis in patients with portal hypertensive colopathy (PHC).


METHODS
We report three cirrhotic patients who were admitted with abdominal sepsis and who illustrate, to various degrees, the clinico-pathological sequence of colonic alterations associated with portal hypertension. Two cirrhotic patients with PHC developed gram-negative bacteraemia and quickly responded to intravenous antibiotics. Another cirrhotic patient underwent emergency colectomy for PC, and subsequently died from multiple organ failure. Histological alterations in the operative specimen included: a) mucosal ulcerations; b) disseminated micro-abscesses in the submucosa; and c) a severe vasculopathy leading to complete obliteration of submucosal blood vessels.


CONCLUSIONS
These data suggest that cirrhotic patients with PHC may progress towards PC, which, in turn, may be the cause for life-threatening sepsis.
Holzer
Thomas
T
Department of Surgery, Geneva University Hospital and Medical School, 1211 Geneva, Switzerland. thomas.holzer@hcuge.ch
Gervaz
Pascal
P
Spahr
Laurent
L
McKee
Thomas
T
Bucher
Pascal
P
Morel
Philippe
P
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003082:Colectomy / Q000379:methods; D003092:Colitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003106:Colon / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents