Typhoid Ulcers
Typhoid Ulcer

Video Endoscopic Sequence 1 of 12.

Typhoid ulcers causing life-threatening bleeding

This is a 16 year-old female, presenting with massive enterorrhagia, The clinical picture had been a recurring process of continuous fever up to 104 Fahrenheit and headaches of two weeks.

She was found unconscious and It is hospitalized, after correcting the hypovolemic shock with blood transfusion that was up to 5 units.
A colonoscopy is performed by finding abundant blood remains in the entire colon, finding in the cecum multiple irregular ulcers as well as in the terminal ileum.

We report a case of a patient with typhoid fever who developed severe haematochezia and was found to have multiple cecal ulcers and also multiple terminal ileum ulcers on colonoscopy. She was managed successfully with conservative measures without endotherapy and there was no rebleed. The patient was discharged six days after admission.
It was documented infection with S. tiphy in blood cultures and histopathology.

Ulcerations generally occur in the terminal ileum, cecum and the ascending colon, and rarely in the left side of the colon

The well-known complications of typhoid fever are intestinal haemorrhage and perforation. In the pre-antibiotic era, these complications were quite common, but in the current antibiotic era the incidence of these complications is on the decline.

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Typhoid ulcers causing life-threatening bleeding

Video Endoscopic Sequence 2 of 12.

Typhoid ulcers causing life-threatening bleeding

Multiple ulcers in the cecum

Typhoid fever and paratyphoid fever is a systemic infection caused by Salmonella enterica, including S. enterica serotype Typhi (S. typhi) and serotype Paratyphi (S. paratyphi). Enteric fever is a faecal-oral transmissible disease and thus occurs in an environment with overcrowding, poor sanitation and untreated water.

Complications occur in 10 to 15% of patients and are particularly likely in patients who have been ill for more than two weeks. Many complications have been described, of which gastrointestinal bleeding, intestinal perforation, and typhoid encephalopathy are the most important. Gastrointestinal bleeding is the most common symptom and it occurs in up to 10% of patients. It results from the erosion of a necrotic Peyer's patch through the wall of an enteric vessel. In the majority of cases, the bleeding is slight and resolves without the need for blood transfusion. In 2% of cases, however, bleeding is clinically significant and can be rapidly fatal if a large vessel is involved. Intestinal (usually ileal) perforation is the most serious complication of the disease and it occurs in 1 to 3% of hospitalized patients.

 

Typhoid Ulcer

Video Endoscopic Sequence 3 of 12.

Appendix hole area

Intestinal bleeding in typhoid fever usually occurs from the ulcers in the ileum or the proximal colon, and the most common colonoscopic manifestations are multiple variable-sized punched-out ulcerations. The shape of the ulcers is usually ovoid with the longest diameter parallel to the long axis of the gut, so that stricture formation does not occur after healing. The edges are soft, swollen and irregular, but not undermined. The floor is usually smooth and is formed by the muscular coat. Near the ileocecal valve, where perforation occurs more commonly, ulcers become deeper than elsewhere. Although uncommon, sporadic cases of typhoid fever still occur.

 

Typhoid Ulcers

Video Endoscopic Sequence 4 of 12.

Terminal Ileum Typhoid Ulcers

Involvement of the small intestine is nearly universal. Hemorrhage and intestinal perforation are the two major complications of small intestinal typhoid infection. Therapy for hemorrhaged small intestine in typhoid fever is initially supportive, consisting of blood transfusions and administration of antibiotics. In massive or recurrent hemorrhage, consideration is given to surgical resection of the involved small-intestinal segment. Operative management of the complications of small intestinal typhoid infection has a high associated mortality rate. Here we report a case of typhoid ileitis with massive hemorrhage from diffuse punched-out ulcerations and erosions in the terminal ileum successfully treated by surgical excision of the diseased part.

 

 

 

 

 


Terminal Ileum Typhoid Ulcer

Video Endoscopic Sequence 5 of 12.

Terminal Ileum Typhoid Ulcer

 

 

Terminal Ileum Typhoid Ulcer

Video Endoscopic Sequence 6 of 12.

Terminal Ileum Typhoid Ulcer

 

Terminal Ileum Typhoid Ulcer

Video Endoscopic Sequence 7 of 12.

Terminal Ileum Typhoid Ulcer

 

Terminal Ileum Typhoid Ulcers

Video Endoscopic Sequence 8 of 12.

Terminal Ileum Typhoid Ulcers

 

 

Typhoid Ulcer

Video Endoscopic Sequence 9 of 12.

Terminal Ileum Typhoid Ulcers

We proceed to obtain their respective biopias which were negative for granulomatous disease or lymphoma.

Typhoid Ulcer

Video Endoscopic Sequence 10 of 12.

Terminal Ileum Typhoid Ulcers

One of the observed ulcers with the traction exerted by the biopsy forceps.

 

Typhoid Ulcer

Video Endoscopic Sequence 11 of 12.

Typhoid ileo-colitis Ulcers

 

Poliposis juvenil

Video Endoscopic Sequence 12 of 12.

It is observed one ulcer of the cecum with abundant blood remaining.

Typhoid Fever.

Colonoscopy in Typhoid Fever

As a complication of typhoid fever, developed massive fresh bleeding per rectum. During colonoscopy, was discovered to have multiple bleeding ulcers lesion in the terminal ileum and ileocecal region.

Intestinal hemorrhage due to a typhoid fever.
The ileocecal valve and the terminal ileum are seen in the video clip. The most frequent and severe complication is intestinal perforation with peritonitis

There are several tiny and bleeding ulcers.
Invasion of Peyer patches occurs during either the primary intestinal infection or secondary bacteremia, and further seeding occurs through infected bile.

The Peyer patches become hyperplastic with infiltration of chronically inflamed cells, which may lead to necrosis of the superficial layer and ulcer formation, with potential hemorrhage from blood vessel erosion or peritonitis from transmural perforation.

Typhoid fever and paratyphoid fever is a systemic infection caused by Salmonella enterica, including S. enterica serotype Typhi (S. typhi) and serotype Paratyphi (S. paratyphi). Enteric fever is a faecal-oral transmissible disease and thus occurs in an environment with overcrowding, poor sanitation and untreated water.

Intestinal bleeding in typhoid fever usually occurs from the ulcers in the ileum or the proximal colon, and the most common colonoscopic manifestations are multiple variable-sized punched-out ulcerations. The shape of the ulcers is usually ovoid with the longest diameter parallel to the long axis of the gut, so that stricture formation does not occur after healing. The edges are soft, swollen and irregular, but not undermined. The floor is usually smooth and is formed by the muscular coat. Near the ileocecal valve, where perforation occurs more commonly, ulcers become deeper than elsewhere. Although uncommon, sporadic cases of typhoid fever still occur.

 

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