Diagnostic Dilemma in the Treatment of a Fatal Case of Bloody Diarrhea

Sidharth Mahapatra, Sara A. Michie, Karl Sylvester, David Cornfield

Research output: Contribution to journalArticle

Abstract

Although diarrhea is the most commonly reported pediatric illness in the United States, mortality is usually a rare and unexpected event. We report the case of a healthy 13-month-old male that succumbed to a diarrheal illness of unclear etiology. Presenting signs included frequent nonbloody stools that progressed to frankly bloody stools over 72 hours. Associated symptoms included fever, tenesmus, relief with stool passage, and significant fatigue. On examination, the patient appeared tired and lay with legs curled toward his chest. The abdominal exam was remarkable for hypoactive bowel sounds, diffuse tenderness to palpation without guarding or rebound pain, and intermittent prolapse of rectal tissue. Abdominal plain films demonstrated a paucity of bowel gas, especially in the rectum; and ultrasound revealed thickening of bowel loops in the left lower quadrant. Abdominal computed tomography scan showed decreased enhancement of the mucosa of the rectosigmoid colon. The patient deteriorated rapidly with cardiorespiratory arrest occurring 48 hours after admission. Despite a protracted effort at cardiopulmonary resuscitation, perfusing heart rate or rhythm could not be reestablished. Autopsy revealed infarction and necrosis of the rectosigmoid colon with invasive gram-negative bacilli. Here we present his perplexing case, diagnostic evaluations, and suggest a unifying diagnosis.

Original languageEnglish (US)
JournalJournal of Investigative Medicine High Impact Case Reports
Volume4
Issue number1
DOIs
StatePublished - Mar 17 2016

Keywords

  • diarrhea
  • food protein–induced enterocolitis syndrome
  • intussusception
  • septic shock

ASJC Scopus subject areas

  • Epidemiology
  • Safety, Risk, Reliability and Quality
  • Safety Research

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