Bleeding typhoid ulcer
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Bleeding typhoid ulcer Ashlesha Satish Udare & Prabath Kumar Mondel & Abhijit Raut
Published online: 15 January 2013 # Indian Society of Gastroenterology 2013
A 45-year-old gentleman presented with fever and abdominal pain of 4 weeks duration and maroon colored stools for 2 days. Clinical examination revealed periumbilical tenderness and mild splenomegaly. The patient was hemodynamically stable. Blood cultures grew Salmonella typhi. Abdominal ultrasonography and CT revealed mild splenomegaly, terminal ileal thickening and enlarged mesenteric lymph nodes. CT angiography
(CTA) revealed active extravasation of contrast into the ileal lumen [Fig. 1]. This finding was confirmed on digital subtraction angiography done preoperatively for methylene blue injection and localization of the bleeding site. The patient recovered after surgery. Typhoid fever is a systemic infection caused by S. typhi and Salmonella paratyphi. Complications occur in 10 % to 15 % of patients and are more likely after the second week. Hemorrhage and bowel perforation are the two
Fig. 1 Unenhanced (a) axial MDCT scan image in the lower abdomen shows no hyperattenuating material within the terminal ileum (arrow). Corresponding CTA (b) image obtained immediately after contrast
administration demonstrates pooling of contrast material within the terminal ileum lumen (arrow). [Contrast in iliac vessels (curved arrow)]
A. S. Udare (*) : P. K. Mondel Department of Radiology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai 400 012, India e-mail: [email protected] A. Raut Seven Hills Hospital, Mumbai, India
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major complications. Gastrointestinal (GI) bleeding results from the erosion of a necrotic Peyer’s patch through the bowel wall [1]. The CTA diagnosis of active bleeding from ulcer is made when hyperdense contrast is seen in the lumen of the bowel outside the confines of the vascular system. Because of the intermittent nature of GI bleeding, CTA should be done as soon as possible after the clinical detection of active GI hemorrhage to maximise detection rates [2].
Indian J Gastroenterol (March–April 2013) 32(2):137–138
References 1. Ezzat RF, Hussein HA, Baban TS, et al. Typhoid ulcer causing life threatening bleeding from Dieulafoy’s lesion of the ileum in a seven-year-old child: a case report. J Med Case Rep. 2010;4:171. 2. Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW. Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics. 2007;27:1055–70.
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