title: Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.
abstract: Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.
authors.affiliation: College of Medicine, University of Sulaymaniyah, Kannat Street, Sulaymaniyah, Iraqi Kurdistan 0532, Iraq.
authors.forename: Mohammad A R
authors.initials: MA
authors.lastname: Shaikhani
authors.forename: Hiwa A B
authors.initials: HA
authors.lastname: Husein
authors.forename: Taha A
authors.initials: TA
authors.lastname: Karbuli
authors.forename: Mohamed Abdulrahman
authors.initials: MA
authors.lastname: Mohamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057908:Argon Plasma Coagulation; D002648:Child; D003108:Colonic Diseases / Q000382:microbiology / Q000628:therapy*; D003113:Colonoscopy; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000382:microbiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007077:Ileal Diseases / Q000382:microbiology / Q000628:therapy*; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D014435:Typhoid Fever / Q000150:complications* / Q000473:pathology; D055815:Young Adult
chemical_list: D004837:Epinephrine