title: Salmonella sepsis simulating gastrointestinal ischaemia following cardiopulmonary bypass.
abstract: Cardiac surgery is commonly associated with gastrointestinal complications. The incidence of severe abdominal pathology ranges from 0.5% to 3% and is associated with a 30% risk of mortality. Frequently occurring complications include splanchnic infarction, perforated bowel, pancreatitis, upper intestinal bleeding and diverticulitis. Systemic and localised infections are also common after open heart surgery. Plasma proteins, neutrophils, monocytes, endothelial cells and lymphocytes are all altered by cardiopulmonary bypass (CPB). Cell mediated immunity is depressed following exposure to the extra-corporeal circuit leading to an increased susceptibility and vulnerability to pathogens. Typhoid fever is the systemic manifestation of Salmonella typhi septicaemia. Its presentation can be similar to that of abdominal ischaemia making the diagnosis of this potentially fatal multi-systemic illness challenging. We report a fatal case of salmonella septicaemia convincingly masquerading as mesenteric ischaemia following routine CPB.
authors.affiliation: Department of Cardiothoracic Surgery, London Chest Hospital, Bonner Road, London E2 9JX, UK. c_efthymiou@hotmail.com
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Efthymiou
authors.forename: William I
authors.initials: WI
authors.lastname: Weir
mesh_terms: D000368:Aged; D001344:Autopsy; D016470:Bacteremia / Q000175:diagnosis* / Q000628:therapy; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D018450:Disease Progression; D017809:Fatal Outcome; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis; D011859:Radiography; D012480:Salmonella Infections / Q000175:diagnosis* / Q000628:therapy; D012485:Salmonella typhi / Q000302:isolation & purification