Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Toxic Megacolon as a Complication of Infectious Colitis Caused by Salmonella enteritidis Group D in a Previously Healthy Child

건강한 소아에서 살모넬라 장염의 합병증으로 발생한 독성거대결장

  • Jeon, Sung Bae (Department of Pediatrics, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • So, Cheol Hwan (Department of Pediatrics, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • Jo, Young Min (Department of Pediatrics, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • Yu, Seung Taek (Department of Pediatrics, Wonkwang University Hospital, Wonkwang University School of Medicine)
  • 전성배 (원광대학교 의과대학병원 소아청소년과) ;
  • 소철환 (원광대학교 의과대학병원 소아청소년과) ;
  • 조영민 (원광대학교 의과대학병원 소아청소년과) ;
  • 유승택 (원광대학교 의과대학병원 소아청소년과)
  • Received : 2020.10.29
  • Accepted : 2021.06.18
  • Published : 2021.08.25
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Abstract

Toxic megacolon is a fatal complication of inflammatory or infectious bowel disease. Prognosis depends on the severity of the disease. In cases of poor prognosis, clinical outcomes range from intestinal resection to death, so early diagnosis and appropriate treatment are very important. However, the prevalence of toxic megacolon in children is very low, and in those without underlying diseases such as inflammatory bowel disease, early diagnosis may be delayed. A previously healthy 12-year-old boy presented to our hospital with lower abdomen pain, fever, and hematochezia. Despite antibiotic therapy, the symptoms worsened. On the third day, abdominal computed tomography revealed severe dilatation of the transverse colon, which indicated toxic megacolon. Stool culture was positive for Salmonella enteritidis group D, and rectal endoscopy showed no signs of inflammatory bowel disease. Ceftriaxone and intravenous methylprednisolone were administered, and the patient's condition improved without any complications. We report a case of toxic megacolon as a complication of infectious colitis caused by S. enteritidis group D, which was diagnosed using early imaging and successfully treated without surgical intervention.

독성거대결장은 염증성 장질환, 감염성 대장염 등에 의해 발생하는 치명적인 합병증이다. 중증도에 따라 장절제부터 사망까지 예후가 나빠 조기 진단과 적절한 치료가 매우 중요한 질환이다. 하지만, 소아에서 그 유병률은 매우 낮으며 염증성 장질환과 같은 기저질환이 없이 발생할 경우 조기진단이 늦어질 수 있다. 기저질환이 없는 12세 남자가 하복부 통증과 발열, 그리고 혈변을 주소로 병원을 방문했다. 항생제 치료에도 불구하고 환자의 증상은 악화되었다. 3병일째 복부 컴퓨터단층촬영에서 횡행결장의 심각한 팽창이 관찰되었고 이를 통해 독성거대결장으로 진단할 수 있었다. 광범위항생제와 함께 정맥 스테로이드 치료를 시행하였으며, 환자의 증상은 호전되었다. 이후 대변 배양 검사에서 Salmonella enteritidis group D가 배양되었으며, 직장 내시경 검사를 통해 염증성 장질환을 배제할 수 있었다. 저자는 독성거대결장을 적절한 영상 검사를 통해 조기 진단하였고, 내과적으로 성공적인 치료를 하여 이에 대한 경험을 공유하고자 한다.

Keywords

Acknowledgement

This study was supported by a 2020 grant from the Wonkwang University.

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