title: An occurrence of sepsis during inpatient fecal disimpaction.
abstract: Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient's illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians' indices of suspicion for uncommon complications of common procedures.
authors.affiliation: Naval Medical Center Portsmouth, Department of Pediatrics, 620 John Paul Jones Cir, Portsmouth, VA 23708. cory.darrow@med.navy.mil.
authors.forename: Cory J
authors.initials: CJ
authors.lastname: Darrow
authors.forename: Justin F
authors.initials: JF
authors.lastname: Devito
mesh_terms: D002400:Cathartics / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D003248:Constipation / Q000150:complications / Q000188:drug therapy*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology*
chemical_list: D002400:Cathartics; D011092:Polyethylene Glycols
keywords: Escherichia coli; bacterial translocation; constipation; sepsis